An entry guide manipulator with a roll system and an instrument manipulator positioning system

ABSTRACT

A surgical system uses a single entry port in a wide variety of surgeries. To insert multiple surgical instruments into a patient through a single entry port requires that the shaft of at least one of the surgical instruments be bent between the base of the surgical instrument and the point where the shaft contacts a channel in an entry guide. Each surgical instrument is positioned by an instrument manipulator positioning system so that when the shaft is inserted in a channel of the entry guide, any bending of the shaft does not damage the surgical instrument and does not inhibit proper operation of the surgical instrument.

RELATED APPLICATIONS

This application claims priority to and the benefit of:

-   -   U.S. Patent Application No. 62/038,096, (filed Aug. 15, 2014,        disclosing “A Surgical System With Variable Entry Guide        Configurations,” by Anthony K. McGrogan et al.); and    -   U.S. Patent Application No. 62/038,106, (filed Aug. 15, 2014,        disclosing “An Entry Guide Manipulator With A Roll System and An        Instrument Manipulator Positioning System,” by Anthony K.        McGrogan et al.), each of which is incorporated herein by        reference in its entirety.

BACKGROUND

1. Field of Invention

The present invention relates generally to surgical instruments, andmore particularly to positioning of surgical instruments.

2. Description of Related Art

Surgical systems, such as those employed for minimally invasive medicalprocedures, can include large and complex equipment to precisely controland drive relatively small tools or instruments. FIG. 1A illustrates anexample of a known teleoperated controlled system 100. System 100, whichmay, for example, be part of a da Vinci® Surgical System commercializedby Intuitive Surgical, Inc., includes a patient-side cart 110 havingmultiple arms 130. Each arm 130 has a docking port 140 that generallyincludes a drive system with a mechanical interface for mounting andproviding mechanical power for operation of an instrument 150. Arms 130can be used during a medical procedure to move and position respectivemedical instruments 150 for the procedure.

FIG. 1B shows a bottom view of a known instrument 150. Instrument 150generally includes a transmission or backend mechanism 152, a main tube154 extending from the backend mechanism 152, and a functional tip 156at the distal end of main tube 154. Tip 156 generally includes a medicaltool such as scissors, forceps, or a cauterizing instrument that can beused during a medical procedure. Drive cables or tendons 155 areconnected to tip 156 and extend through main tube 154 to backendmechanism 152. Backend mechanism 152 typically provides a mechanicalcoupling between the drive tendons 155 of instrument 150 and motorizedaxes of the mechanical interface of a docking port 140. In particular,gears or disks 153 engage features on the mechanical interface of adocking port 140. Instruments 150 of system 100 can be interchanged byremoving one instrument 150 from a drive system 140 and then installinganother instrument 150 in place of the instrument removed.

SUMMARY

A surgical system includes a single entry port, which may be used in awide variety of different surgical procedures. The variety of surgicalprocedures uses various combinations of instruments that enter a patientthrough the single entry port. The instruments, in one aspect, aregrouped into sets of instruments based on the shaft characteristics ofthe instruments, e.g., standard surgical instruments (graspers,retractors, scissors, cautery, and the like), advanced surgicalinstruments (staplers, vessel sealers, and the like) that may have across section larger than standard surgical instruments or unique crosssections, and camera instruments (visible, infrared, ultrasound, and thelike) that also may have a cross section larger than standard surgicalinstruments or unique cross sections. These instruments can be manuallycontrolled, controlled with computer assistance (fully or cooperativelycontrolled), or teleoperatively controlled.

The different surgeries that can be performed using at least one entryport may be performed on different regions of the body. For example, onesurgery may be performed through the mouth of a patient; another surgerymay be performed between the ribs of a patient; and other surgeries maybe performed through other natural or incision orifices of a patient.Not only is the surgical system configured to use a variety ofinstruments, but also the surgical system is configured to use a varietyof different entry guides, which guide the instruments into the patienttoward the surgical site. At least a portion of each instrument isinserted through a corresponding channel in an entry guide. Typically, adifferent entry guide is used for each different type of surgery. Theentry guide selected for a particular surgical procedure may maintain aninsufflation seal, if necessary, and entry guide supports the shafts ofthe instruments at the entry point into the body of the patient.

To insert multiple instruments into a patient through a single entryport may require one or more of the shafts of the instruments to bendbetween where the shaft is connected to the housing of the instrumentand the point where the shaft contacts a channel of the entry guide.This bend may be permanently pre-formed in a rigid instrument, such as acamera instrument, or may happen non-permanently when inserting theshaft of an instrument into a channel of the entry guide. If the shaftof the instrument is bent too much, the shaft of the instrument may bedamaged and/or the instrument may not perform properly during thesurgery.

An entry guide manipulator controls the position and orientation of anentry guide. The entry guide includes two or more channels. Each channelreceives a surgical instrument and guides the surgical instrument towardthe surgical site. Thus, two or more instruments are guided toward thesurgical site via a single opening (port) in the body. An entry guidechannel may be configured to receive an individual instrument type, suchas a camera with an oval cross section. Or, an entry guide channel maybe configured to receive many instrument types, such as therapeuticinstruments with round cross sections. Various combinations of entryguide channel configurations may be used. The entry guide manipulatoralso controls the position and orientation of the instruments thatextend through the entry guide channels. Thus, in one aspect, eachentire instrument is positioned by the entry guide manipulator so thatwhen the instrument's shaft is inserted in the channel of the entryguide, any bending of the shaft is not permanent and does not inhibitproper operation of the instrument such as for insertion/withdrawal orroll (if applicable). This positioning assures that any bending does notdamage the instrument, and that any bending does not affect the correctoperation of the instrument. Various entry guide channel arrangementsmay be used, each arrangement being associated with a different singleentry port area in a patient. For example, an entry guide may have acircular cross section with its channels arranged generally equallyspaced within the cross section. As a second example, an entry guide mayhave an oblong cross section with its channels arranged generally in aline. Therefore, in one aspect, for each entry guide with a differentchannel configuration, each instrument is positioned so that stressesinduced by any bend in the shaft remain within a predetermined stressprofile for the individual instrument, i.e., the stress on the shaft iscontrolled such that the shaft does not yield and permanently changeshape. Additionally, the stress is maintained so that as the shaft rollsin the entry guide or is inserted and withdrawn through the entry guide,the cycling stress does not fatigue and break the shaft. This cyclingstress load is a consideration associated with instrument life. And so,an individual instrument type is placed at a first location for entryinto a corresponding channel in a first entry guide configuration, andthe individual instrument type is placed at a different, second locationfor entry into a corresponding channel in a second entry guideconfiguration.

In one aspect, the entry guide manipulator simultaneously positionsinstrument mount interfaces for the instruments with respect to thechannels in an entry guide so that when the shafts of the instrumentsare inserted into channels in the entry guide, any bending of theinstrument shafts does not damage the instruments and does not inhibitoperation of the instruments. If an instrument shaft is bent to thepoint that the shaft does not return to its original shape whenwithdrawn from the entry guide, the instrument is considered damaged.The entry guide manipulator is configured to make these positionadjustments for each entry guide in a family of entry guides, and in oneaspect, the position adjustments for the entire instrument is made withlittle or no user input.

In addition, the instrument manipulator positioning system eliminatesthe need for surgical procedure-specific instruments. In other words,the instrument manipulator positioning system allows use of a common setof instruments with a variety of entry guides by moving the instrumentshafts as appropriate for use of each of the entry guides.

A surgical system includes an entry guide. In one aspect, the entryguide has a first channel and a second channel. The surgical system alsoincludes a first instrument with a first shaft, and a second instrumentwith a second shaft. A manipulator in the system is coupled to the firstand second instruments.

The manipulator includes an instrument manipulator positioning system.The instrument manipulator positioning system is configured to move afirst instrument mount interface for the first instrument and to move asecond instrument mount interface for the second instrument so that afirst shaft of a first instrument is positioned for insertion into thefirst channel of the entry guide, and so that a second shaft of a secondinstrument is positioned for insertion into the second channel of theentry guide. Thus, the movement of the two interfaces by the instrumentmanipulator positioning system effectively aligns the two shafts withthe corresponding channels in the entry guide. In one aspect, the firstand second instrument mount interfaces are moved before the first andsecond instruments are mounted on the respective interfaces. While twoinstruments are used as an example, in one aspect, the instrumentmanipulator positioning system can position any combination of a desirednumber of instruments so that shafts of the instruments can be insertedinto corresponding channels in an entry guide.

As used herein, “align” does not require that a lengthwise axis of achannel and a lengthwise axis of the shaft be coincident. Rather,“align” means that the shaft is in position for entry into the channelwithout damage, and that the entry may require a non-permanent bend inthe shaft. In some instances, however, the lengthwise axis of one ormore instrument shafts and one or more corresponding entry guidechannels are truly coincident, and so no shaft bending occurs. Thus in afirst positioning state of two or more instruments, the instruments arepositioned so that their shafts each enter, without bending,corresponding channels of a first entry guide arranged in a firstconfiguration, and in a second positioning state of the two or moreinstruments, the instruments are positioned so that their shafts eachenter, without bending, corresponding channels of a second entry guidearranged in a second configuration. Optionally, in the secondpositioning state of the two or more instruments, the instruments arepositioned so that one or more of the instrument shafts bend as theshafts enter a corresponding channel of the second entry guide arrangedin the second configuration. Thus, for various positioning states of theinstruments with reference to corresponding entry guide configurations,various combinations of shaft bending or non-bending are made as needed,based on the instrument shafts and the entry guide channelconfigurations.

In one aspect, the instrument manipulator positioning system includes anadjustment gear that is coupled to each of the first instrument mountinterface for the first instrument and the second instrument mountinterface for the second instrument. In one aspect, movement of theadjustment gear simultaneously moves the first and second instrumentmount interfaces into the positions where insertion of the shafts intothe first and second channels is possible without damaging theinstruments, e.g., the shafts of the first and second instruments aresufficiently aligned with the first and second channels, respectively,when the first and second instruments are mounted on the first andsecond instrument mount interfaces, respectively. In a further aspect,the instrument manipulator positioning system also includes a manuallyoperated knob coupled to the adjustment gear. A user turns the knobwhich in turn causes the adjustment gear to rotate and move theinstruments coupled to the adjustment gear. Again, the use of twoinstrument mount interfaces is an example and is not intended to belimiting. In general, the adjustment gear can be coupled to a number ofinstrument mount interfaces necessary to move instruments into a properposition for use with an entry guide of interest, e.g., four instrumentmount interfaces.

In yet another aspect, a user manually moves each instrument mountinterface of a plurality of instrument mount interfaces, as needed, in adirection perpendicular to a lengthwise axis of an entry guide to aproper location. A pin may be used to lock each instrument mountinterface in the desired location. In some situations, not all of theplurality of instrument mount interfaces may need to be moved. Theproper location for a particular instrument mount interface can bedetermined by a location of a through hole in a disk of the instrumentmanipulator positioning system, for example. Alternatively, the properlocation can be determined by allowing the instrument mount interface tomove to a location which minimizes any bend in the shaft of theinstrument mounted to the instrument mount interface after the shaft isinserted into the entry guide with the lengthwise axis of the entryguide being vertical.

In yet another aspect, the instrument manipulator positioning systemincludes a first plurality of motors and a second plurality of motors.Each plurality of motors is coupled to a different instrument mountinterface. Each plurality of motors positions the correspondinginstrument mount interface for the instrument so that when theinstrument is mounted on the instrument mount interface, the shaft ofthe instrument is aligned with a channel in an entry guide, e.g., theshaft can be positioned in the channel.

In still another aspect, the instrument manipulator positioning systemfurther includes a first gearbox coupled to the first instrument, and asecond gearbox coupled to the second instrument. A gear is coupled tothe first and second gearboxes. As the gear is moved, the movement ofthe gear causes the first and second gearboxes to simultaneously movethe first and second instrument mount interfaces into the positionswhere insertion of the shafts into the first and second channels ispossible without damaging the instruments. In one aspect the gear is aroll gear, and another aspect the gear is an adjustment gear.

In one aspect, the first gearbox includes a gear having a side surface.A pin is coupled to the side surface of the gear. In one aspect, the pinhas one degree of freedom. The pin is coupled to the instrument mountinterface so that as the pin moves, the first instrument mount interfacemoves, and consequently a distal end of the shaft is effectively movedin the same arc as the pin. Here, “effectively moved” means that eventhough the entire instrument may not be mounted to the instrument mountinterface when the instrument mount interface moves, when the entireinstrument is mounted to the instrument mount interface, the location ofthe shaft relative to the entry guide has been moved compared to thelocation of the shaft relative to the entry guide if the instrument hadbeen mounted before the instrument mount interface was moved.

In another aspect, the second gearbox includes a gear having a sidesurface. A pin is coupled to the side surface of the gear. The sidesurface of the gear of the second gearbox includes a cam. The pin rideson the cam. In one aspect, the pin has one degree of freedom, and inanother aspect, the pin has two degrees of freedom. The pin is coupledto the second instrument mount interface so that as the pin moves, thesecond instrument mount interface moves, and consequently a distal endof the shaft of the second instrument is effectively moved with the samemotion as the pin.

In yet another aspect, the entry guide includes first identificationinformation and the first instrument includes second identificationinformation. The apparatus includes a control system configured toreceive the first identification information and to receive the secondidentification information. The control system configures the apparatusbased on the first identification information, in one aspect.

An apparatus includes a first entry guide having a first channelconfiguration and a second entry guide having a second channelconfiguration. The first channel configuration is different from thesecond channel configuration.

The apparatus also includes a surgical system. Only one of the firstentry guide and the second entry guide is mounted in the surgical systemduring a surgical procedure.

The surgical system includes an instrument having a shaft. An instrumentmanipulator positioning system is coupled to the instrument. Based onthe channel configuration of the entry guide mounted in the surgicalsystem, the instrument manipulator positioning system moves theinstrument to a predetermined location to align the shaft with a channelof the entry guide, e.g., positions the shaft to enable insertion of theshaft into the channel of the entry guide. The predetermined locationmaintains bending stress on the shaft within a predetermined stressprofile, in one aspect.

Since multiple entry guides with different channel configurations can beused in the surgical system, the instrument manipulator positioningsystem of the entry guide manipulator is configured to move a pluralityof instrument mount interfaces to enable insertion of shafts of a firstplurality of instruments into a first entry guide having a first channelconfiguration. The instrument manipulator positioning system is alsoconfigured to move the plurality of instrument mount interfaces toenable insertion of shafts of a second plurality of instruments into asecond entry guide having a second channel configuration. The secondchannel configuration is different from the first channel configuration.The first plurality of instruments can be either the same as ordifferent from the second plurality of instruments.

In one aspect, a method includes an instrument manipulator positioningsystem simultaneously moving a first instrument manipulator and a secondinstrument manipulator so that if a first instrument is mounted to thefirst instrument manipulator, a shaft of the first instrument is alignedwith a first channel in a first entry guide, and so that if a secondinstrument is mounted to the second instrument manipulator, a shaft ofthe second instrument is aligned with a second channel of the firstentry guide. The method also includes the instrument manipulatorpositioning system simultaneously moving the first instrumentmanipulator and the second instrument manipulator so that if a thirdinstrument is mounted to the first instrument manipulator, a shaft ofthe third surgical instrument is aligned with a first channel in asecond entry guide, and so that if a fourth instrument is mounted to thesecond instrument manipulator a shaft of the fourth instrument isaligned with a second channel of the second entry guide. A channelconfiguration of the first entry guide is different from a channelconfiguration of the second entry guide, and the first entry guide andthe second single guide are used at different times.

In another aspect, a method includes moving an entry guide having alengthwise axis so that the lengthwise axis is vertical. Then, a shaftof a surgical device assembly is inserted into a channel of the entryguide, and the entire surgical device assembly is allowed to move to aposition of least energy. Finally, the surgical device assembly islocked to a disk.

In one aspect, the first entry guide has a circular cross section, andthe second entry guide has a non-circular cross section. One or both ofthe first and second entry guides can include a manual instrumentchannel.

The apparatus also includes a first camera instrument having a firstshaft with a first bend at a first location. The first camera instrumentis mounted in the surgical system when the first entry guide is mountedin surgical system. A second camera instrument has a second shaft with asecond bend at second location. The second camera instrument is mountedin the surgical system when the second entry guide is mounted in thesurgical system. The first location is different from the secondlocation.

In one aspect, a kit of entry guides includes a plurality of entryguides. Each entry guide includes a plurality of channels. A channelconfiguration of each entry guide is different from a channelconfiguration in each of the other entry guides in the plurality ofentry guides. Each entry guide in the plurality is separately mountablein a same surgical system.

In one aspect, a first guide in the plurality includes a camera channeland a plurality of surgical instrument channels. A second entry guide inthe plurality includes a camera channel and a manual instrument channel.

In another aspect, a first entry guide in the plurality includes acamera channel and a plurality of surgical instrument channels. A secondentry guide in the plurality includes a camera channel and an advancedsurgical instrument channel.

In still another aspect, a first entry guide includes a circular crosssection. A second entry guide includes a non-circular cross section.

In still yet another aspect, a first entry guide in the pluralityincludes a camera channel and a plurality of surgical instrumentchannels. A second entry guide in the plurality has an oblong-shapedcross section. The oblong shape has a major axis. The second entry guideincludes a camera channel having a first lengthwise axis, a firstsurgical instrument channel having a second lengthwise axis, and asecond surgical instrument channel comprising a third lengthwise axis. Alengthwise axis extends from a proximal end of a channel to a distal endof the channel. The first, second, and third lengthwise axes intersectthe major axis of the oblong cross section of the second entry guide.

In still a further aspect, a first entry guide in the plurality includesa camera channel and a plurality of surgical instrument channels. Asecond entry guide in the plurality includes a camera channel. Thecamera channel has an oblong-shaped cross section. The oblong-shapedcross section has a major axis and a minor axis. The second entry guidealso includes a first surgical instrument channel having a firstlengthwise axis, a second surgical instrument channel having a secondlengthwise axis, and a third surgical instrument channel having a thirdlengthwise axis. The first lengthwise axis and the second lengthwiseaxis intersect a first line extending from the major axis. The firstline includes the major axis. The third lengthwise axis intersects asecond line extending from the minor axis. The second line includes theminor axis. The major axis is perpendicular to the minor axis, and sothe first line is perpendicular to the second line.

The surgical system includes a manipulator system. The manipulatorsystem includes a roll system couplable to first and second surgicaldevice assemblies. The roll system is configured to roll the entirefirst and second surgical device assemblies as a group. The manipulatorsystem also includes an instrument manipulator positioning systemcoupled to the roll system and couplable to the first and secondsurgical device assemblies. The instrument manipulator positioningsystem is configured to position first and second instrument interfaceassemblies for the first and second surgical device assemblies to enableinsertion of shafts of the first and second surgical device assembliesinto different channels of an entry guide.

The instrument manipulator positioning system includes an adjustmentgear, and the roll system includes a roll ring gear. The manipulatorsystem also includes a drive assembly. The drive assembly is coupled tothe roll ring gear and coupled to the adjustment ring gear. The driveassembly is configured to differentially rotate the adjustment gear andthe roll ring gear to cause the instrument manipulator positioningsystem to move the first and second instrument interface mounts for thesurgical device assemblies to enable insertion of shafts of the surgicaldevice assemblies into respective channels of an entry guide.

In one aspect, the drive assembly is configured to hold the roll ringgear stationary and is configured to turn the adjustment gear while theroll ring gear is held stationary. In another aspect, the drive assemblyis configured to hold the adjustment gear stationary and is configuredto turn the roll ring gear while the adjustment gear is held stationary.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is an illustration of a portion of a prior art surgical system.

FIG. 1B is an illustration of a prior art surgical device assembly.

FIG. 2A is a schematic illustration of an instrument manipulatorpositioning system and a plurality of surgical device assemblies coupledto the instrument manipulator positioning system.

FIG. 2B is a schematic illustration of an instrument manipulatorpositioning system and a plurality of instrument manipulators beforeinstruments have been coupled to the plurality of instrumentmanipulators.

FIG. 2C is a schematic side view that illustrates aspects of a surgicalsystem that includes an entry guide manipulator with an instrumentmanipulator positioning system.

FIG. 2D illustrates trajectories implemented in the instrumentmanipulator positioning system of FIG. 2C.

FIG. 2E is an illustration of a surgical system that includes an entryguide manipulator configured to position instruments so that when theshafts of the instruments enter an entry guide, any bending of theshafts does not damage the instruments.

FIGS. 3A and 3B are more detailed illustrations of the configuration ofthe surgical device assemblies in FIG. 2E.

FIG. 4A illustrates a manipulator assembly affixed to an insertionassembly that in turn is attached to a base assembly.

FIG. 4B is a more detailed illustration of the instruments of FIGS. 2A,2C, 2E, 3A and 3B.

FIG. 5A is a schematic representation of four base assemblies mounted onthe entry guide manipulator.

FIG. 5B is a cross sectional view of a first entry guide that isreferred to as a standard entry guide.

FIG. 5C is a cross sectional view of a second entry guide.

FIG. 5D shows the first entry guide overlaid on the second entry guide.

FIG. 5E illustrates the result of the instrument manipulator positioningsystem in the entry guide manipulator moving the positioning elementthat is coupled to a surgical instrument.

FIG. 5F illustrates a plurality of, base assemblies having a hexagonalshape that could be mounted on and moved by the entry guide manipulator.

FIG. 6A is an illustration of one implementation of an instrumentmanipulator positioning system in the entry guide manipulator.

FIG. 6B is a cross-sectional view of an entry guide with at least onecanted channel.

FIG. 6C is an illustration of another implementation of an instrumentmanipulator positioning system in the entry guide manipulator.

FIGS. 7A to 7C are a top, bottom, and oblique views respectively of oneaspect of a portion of a base assembly that includes a floatingplatform.

FIG. 7D is a cut-away illustration of one aspect of a positioningelement receptacle assembly.

FIGS. 8A, 8B, and 8C are other examples of the instrument manipulatorpositioning system of FIGS. 2A and 2B that can be included in the entryguide manipulator of FIG. 2C and in the entry guide manipulator of FIG.2E.

FIG. 8D is yet another example of the instrument manipulator positioningsystem of FIGS. 2A and 2B that can be included in the entry guidemanipulator of FIG. 2C and in the entry guide manipulator of FIG. 2E.

FIG. 8E is still another example of the instrument manipulatorpositioning system of FIGS. 2A and 2B that can be included in the entryguide manipulator of FIG. 2C and in the entry guide manipulator of FIG.2E.

FIG. 9 illustrates yet another example of an instrument manipulatorpositioning system.

FIGS. 10A and 10B are proximal and distal views of a circular motiongearbox in a first set of gearboxes for the instrument manipulatorpositioning system of FIG. 9.

FIGS. 10C and 10D are proximal and distal views of a linear motiongearbox in the first set of gearboxes for the instrument manipulatorpositioning system of FIG. 9.

FIGS. 11A and 11B are proximal and distal views of a first gearbox in asecond set of gearboxes for the instrument manipulator positioningsystem of FIG. 9.

FIGS. 11C and 11D are proximal and distal views of a second gearbox inthe second set of gearboxes for the instrument manipulator positioningsystem of FIG. 9.

FIGS. 11E and 11F are proximal views of a third gearbox in the secondset of gearboxes for the instrument manipulator positioning system ofFIG. 9.

FIG. 11G is a distal view of the third gearbox in the second set ofgearboxes for the instrument manipulator positioning system of FIG. 9.

FIG. 11H is a cross-sectional view of the third gearbox in the secondset of gearboxes for the instrument manipulator positioning system ofFIG. 9.

FIGS. 11I and 11J are proximal and distal views of a fourth gearbox inthe second set of gearboxes for the instrument manipulator positioningsystem of FIG. 9.

FIG. 11K is a more detailed illustration of the cam gear of FIG. 11J.

FIGS. 12A to 12D illustrate one aspect of an entry guide manipulatorincluding an instrument manipulator positioning system.

FIGS. 13A and 13D illustrate an alternative aspect of an entry guidemanipulator including an instrument manipulator positioning system.

FIGS. 14A to 14J are illustrations of cross-sections of a family ofentry guides that can be used with the systems of FIGS. 2A, 2C, and 2E.

FIG. 15 is a process flow diagram of a method used to determine therange of motion required and the trajectory to be implemented in each ofthe four gearboxes in FIG. 9 for the family of entry guides in FIGS. 14Ato 14J.

FIG. 16A is a schematic representation of base assemblies mounted on theentry guide manipulator and the coordinate system used by the instrumentmanipulator positioning system.

FIG. 16B is a schematic representation of a surgical instrument with ashaft that is entering an entry guide mounted in a cannula, where theshaft is bent against the entry guide.

FIG. 16C is a schematic top view of three surgical instruments mountedas illustrated in FIGS. 3A and 3B.

FIG. 17 illustrates acceptable stress regions for each positioningelement and the associated entry guide channel showing the allowableoffsets from ideal (minimum stress) instrument shaft positions.

FIG. 18A illustrates the surgical instrument and camera instrumenttrajectories and ranges of motion of gearboxes in FIG. 9 for the familyof entry guides in FIGS. 14A to 14J.

FIG. 18B illustrates the seven locations for the instrument manipulatorassociated with the gearbox of FIGS. 11A and 11B.

FIG. 18C illustrates the seven locations of the output pin in the slotof FIG. 11B.

FIG. 18D illustrates the seven locations for the instrument manipulatorassociated with the gearbox of FIGS. 11C and 11D.

FIG. 18E illustrates the seven locations of the output pin in the slotof FIG. 11D.

FIG. 18F illustrates the seven locations for the instrument manipulatorassociated with the gearbox of FIGS. 11E to 11H.

FIG. 18G illustrates the seven locations of the output pin in the slotof FIG. 11G.

FIG. 18H illustrates the seven locations for the instrument manipulatorassociated with the gearbox of FIGS. 11I to 11J.

FIG. 18I illustrates the seven locations of the output pin in the slotof FIG. 11J.

FIGS. 19A and 19B are schematic illustrations of camera instrumentshaving a pre-bent shaft.

FIG. 20A is a schematic illustration of one aspect of a control systemin the surgical system of FIG. 2E.

FIG. 20B is a process flow diagram of one aspect of a method performedby the instrument manipulator positioning system compatibility module ofFIG. 20A.

FIGS. 21A and 21B are side views illustrating a first example of a wayto attach base assemblies to a portion of the entry guide manipulator.

FIG. 22A is a side view illustrating a second example of a way to attachbase assemblies to a portion of the entry guide manipulator.

FIGS. 22B and 22C are top views of the second example of FIG. 22A.

FIGS. 23A and 23B are side views illustrating a third example of a wayto attach base assemblies to a portion of the entry guide manipulator.

In the drawings, for single digit figure numbers, the first digit in thereference numeral of an element is the number of the figure in whichthat element first appears. For double-digit figure numbers, the firsttwo digits in the reference numeral of an element is the number of thefigure in which that element first appears.

DETAILED DESCRIPTION

A surgical system, e.g., a teleoperated, computer-assisted surgicalsystem, with a single entry port is used in a wide variety of differentsurgeries. The variety of surgical procedures uses various combinationsof instruments that enter a patient through the single entry port. Theinstruments, in one aspect, are grouped into sets of instruments basedon the shaft characteristics of the instruments, e.g., standard surgicalinstruments, advanced surgical instruments, and camera instruments.These instruments can be manually controlled, controlled with computerassistance (fully or cooperatively controlled), or teleoperativelycontrolled.

The different surgeries that can be performed using the single entryport may be performed on different regions of the body. For example, onesurgery may be performed through the mouth of a patient; another surgerymay be performed between the ribs of a patient; and other surgeries maybe performed through other orifices of a patient or through an incisionin the patient. Not only is the surgical system configured to use avariety of instruments, but also the surgical system is configured touse a variety of different entry guides. Typically, a different entryguide is used for each different type of surgery. The entry guideselected for a particular surgical procedure may maintain aninsufflation seal, if necessary, and the entry guide supports the shaftsof the instruments at the entry point into the body of the patient.

A single entry port means that a single incision in a patient or asingle bodily orifice of the patient is used to perform the surgicalprocedure. While a single entry port surgical system is used as anexample, this example is not intended to limit the aspects describedbelow to surgical systems that utilize a single entry port. The aspectsdescribed below can be used in any surgical system that inserts multipleinstruments into a patient through a single entry guide. For example, ifa surgical system utilizes two or more entry ports into a patient, andan entry guide having a plurality of channels is used in any of or allof the two or more entry ports, the aspects described below are directlyapplicable to such a surgical system.

FIG. 2A is a schematic illustration of a plurality of surgical deviceassemblies in a surgical system. A first surgical device assemblyincludes a first instrument manipulator 240A₁ and a first instrument260A1. First instrument 260A1 is mounted to first instrument manipulator240A1. First instrument 260A1 includes a shaft 262A1 that extends in adistal direction from a body of first instrument 260A1. The surgicaldevice assembly including first instrument 260A1 is coupled to aninstrument manipulator positioning system 231A by a first longitudinalmotion mechanism 233A1. Longitudinal motion mechanism 233A1 moves thefirst surgical device assembly in a proximal direction and in a distaldirection. A second surgical device assembly includes a secondinstrument manipulator 240A2 and a second instrument 260A2. Secondinstrument 260A2 is mounted to second instrument manipulator 240A2.Second instrument 260A2 includes a shaft 262A2 that extends in a distaldirection from a body of second instrument 260A2. The second surgicaldevice assembly including second instrument 260A2 is coupled toinstrument manipulator positioning system 231A2 by a second longitudinalmotion mechanism 233A2. Longitudinal motion mechanism 233A2 moves thesecond surgical device assembly in a proximal direction and in a distaldirection.

To insert multiple instruments 260A1, 260A2 into a patient through asingle entry port may require one or more of shafts 262A1, 262A2 ofinstruments 260A1, 260A2 to bend between where the shaft is connected tothe body of the instrument and the point where the shaft contacts achannel of the entry guide 270A. If the shaft of the instrument is benttoo much, the shaft of the instrument may be damaged and/or theinstrument may not perform properly during the surgery.

Thus, in one aspect, each entire instrument 260A1, 260A2 (FIG. 2A) ispositioned by an instrument manipulator positioning system 231A, whichin some aspects is part of an entry guide manipulator, so that when eachshaft 262A1, 262A2 is inserted in a corresponding channel of entry guide270A, any bending of the shaft is not permanent and does not inhibitproper operation of the instrument. This assures that any bending doesnot damage the instrument and that any bending does not affect thecorrect operation of the instrument.

In one aspect, for each entry guide with a different channelconfiguration, instrument manipulator positioning system 231A moves atleast one instrument mount interface 240A1_IMI for an instrument 260A1so that stresses induced by any bend in shaft 262A1 remains within apredetermined stress profile, e.g., the stress on shaft 262A1 iscontrolled such that shaft 262A1 does not yield and permanently changeshape. Additionally, the stress is maintained so that as shaft 262A1rolls in entry guide 270A, the cycling stress does not fatigue and breakshaft 262A1. This cycling stress load can be a consideration associatedwith instrument life.

In one aspect, each instrument mount interface is configured to couplean instrument to an instrument manipulator and to support thatinstrument while coupled. For example, a first instrument mountinterface 240A1_IMI supports instrument 260A1 and couples instrument260A1 to instrument manipulator 240A1, and a second instrument mountinterface 240A2_IMI supports instrument 260A2 and couples instrument260A2 to instrument manipulator 240A2.

For a first entry guide having a first channel configuration, instrumentmanipulator positioning system 231A has a first state, and for a secondentry guide having a second channel configuration, instrumentmanipulator positioning system 231A has a second state. The firstchannel configuration is different from the second channelconfiguration.

In the first state, instrument manipulator positioning system 231A movesinstrument mount interface 240A1_IMI, by moving longitudinal motionmechanism 233A1 and consequently instrument manipulator 240A1, so thatwhen instrument 260A1 is mounted on instrument mount interface240A1_IMI, a distal end 263A1 of shaft 262A1 is aligned with acorresponding channel in the first channel configuration.

In the second state, instrument manipulator positioning system 231Amoves instrument mount interface 240A1_IMI so that when instrument 260A1is mounted on instrument mount interface 240A1_IMI, a distal end 263A1of shaft 262A1 is aligned with a corresponding channel in the secondchannel configuration. If in either the first state or the second state,the shaft is bent upon passing through entry guide 270A, the shaft isaligned with the corresponding channel in the entry guide prior topassing though entry guide 270A so that any bending does not damage theinstrument and does not inhibit proper operation of the instrument.Here, the corresponding channel in the channel configuration is thechannel through which the shaft passes.

Thus, in the first state, at least a portion of instrument mountinterface 240A1_IMI is at a first location in a plane 286B (FIG. 2B).Plane 286B is perpendicular to a longitudinal axis 285A of entry guide270A. In the second state, the portion of instrument mount interface240A1_IMI is moved to a second location in plane 286B, where the secondlocation is different from the first location. Note that when theportion of instrument mount interface 240A1_IMI moves in plane 286B, aportion of instrument manipulator 240A1 also moves in a plane that isparallel to plane 286B.

Numerous examples are presented below of aspects of instrumentmanipulator positioning system 231A that move one or more instrumentmount interfaces in a plane that is perpendicular to the longitudinalaxis of the entry guide. The movement, in one aspect, is in onedimension of plane 286B and in other aspects, the movement is in twodimensions of plane 286B. Each aspect described below of an instrumentmanipulator positioning system has at least one of the two statesdescribed here, and each aspect illustrates a different way to implementthe or each of the two states. In addition, instrument manipulatorpositioning system 231A can be implemented having manual control of themovement of the instrument mount interfaces or having automatic controlof the movement of the instrument mount interfaces.

In one aspect, instrument manipulator positioning system 231Asimultaneously moves instrument interface mounts 240A1_IMI, 240A2_IMIfor instruments 260A1, 260A2 with respect to the channels in entry guide270A, if necessary, so that when shafts 262A1, 262A2 of instruments260A1, 260A2 are passed through channels of entry guide 270, any bendingof instrument shafts 262A1, 262A2 does not damage the instruments anddoes not inhibit operation of instruments 260A1, 260A2. As explainedabove, in some instance, a shaft of an instrument may pass through achannel of the entry guide without any bending. If an instrument shaftis bent to the point that the shaft does not return to its originalshape when withdrawn from entry guide 270, the instrument is considereddamaged. In this aspect, instrument manipulator positioning system 231Ais configured to move each instrument mount interface as required foreach entry guide in a family of entry guides, and in one aspect, theadjustment is made with little or no user input.

In one aspect, instrument manipulator positioning system 231A movesinstrument mount interfaces 240A1_IMI 240A2_IMI, as needed, beforeinstruments 260A1, 260A2 are mounted on instrument manipulatorpositioning system 231A. In one aspect, instrument manipulatorpositioning system 231A is one integral system. In another aspect, thereis an individual instrument manipulator positioning system 231A for eachinstrument. Irrespective of the implementation of system 231A, theoperation is as described herein.

As described above, instrument manipulator positioning system 231A isconfigured to move a first instrument mount interface 240A1_IMI forfirst instrument 260A1 and to move second instrument mount interface240A1_IMI for the second instrument 260A2 in a plane 286B so that firstshaft 262A1 is positioned for insertion into a first channel of entryguide 270A, and so that second shaft 262A2 is positioned for insertioninto a second channel of entry guide 270A. The first and second channelsare different channels. Thus, the movement of the two interfaces byinstrument manipulator positioning system 231A effectively aligns thetwo shafts, e.g., aligns the distal end of the two shafts, with thecorresponding channels in entry guide 270A.

As used herein, “align” does not require that a lengthwise axis of achannel and a lengthwise axis of the shaft be coincident. Rather,“align” means that the shaft is in position for entry into the channelwithout damage and that the entry may require a non-permanent bend inthe shaft. In some instances, however, the lengthwise axis of one ormore instrument shafts and one or more corresponding entry guidechannels are truly coincident, and so no shaft bending occurs. Thus, ina first positioning state of two or more instruments, the instrumentsare positioned so that their shafts each enter, without bending,corresponding channels of a first entry guide arranged in a firstconfiguration, and in a second positioning state of the two or moreinstruments, the instruments are positioned so that their shafts eachenter, without bending, corresponding channels of a second entry guidearranged in a second configuration. Optionally, in the secondpositioning state of the two or more instruments, the instruments arepositioned so that one or more of the instrument shafts bend as theshafts enter a corresponding channel of the second entry guide arrangedin the second configuration. Thus, for various positioning states of theinstruments with reference to corresponding entry guide configurations,various combinations of shaft bending or non-bending are made as needed,based on the instrument shafts and the entry guide channelconfigurations.

In one aspect described below, instrument manipulator positioning system231A includes an adjustment gear that is coupled to each of the firstinstrument mount interface for the first instrument and the second mountinterface for the second instrument. In one aspect, movement of theadjustment gear simultaneously moves the first and second instrumentmount interfaces into the positions where insertion of the shafts intothe first and second channels is possible without damaging theinstruments, e.g., the shafts of the first and second instruments arealigned with the first and second channels, respectively when the firstand second instruments are mounted on the first and second instrumentmount interfaces, respectively. In a further aspect, instrumentmanipulator positioning system 231A also includes a manually operatedknob coupled to the adjustment gear. A user turns the knob which in turncauses the adjustment gear to rotate and move the surgical instrumentscoupled to the adjustment gear. Alternatively, a user manually moveseach instrument mount interface to the proper location and uses a pin tolock the instrument mount interface in that location, for example theinstrument manipulator is locked to a disk in instrument manipulatorpositioning system 231A.

In one aspect, instrument manipulator positioning system 231A, sometimesreferred to as system 231A, includes a plurality of movable platforms,one for each of a plurality of instruments that are coupled to system231A. In one aspect, each moveable platform is connected to alongitudinal motion mechanism, e.g., a first moveable platform iscoupled to longitudinal motion mechanism 233A1 and a second movableplatform is coupled to longitudinal motion mechanism 233A2. Variousexamples of movable platforms are presented below.

Each longitudinal motion mechanism is connected to an instrumentmanipulator assembly, e.g., longitudinal motion mechanism 233A1 isconnected to instrument manipulator assembly 240A1, and longitudinalmotion mechanism 233A2 is connected to instrument manipulator assembly240A2. Each longitudinal motion mechanism moves the connected instrumentmanipulator assembly in a proximal direction and in a distal direction,e.g. in a first direction and a second direction along an extendedlengthwise axis 285A of entry guide 270A.

Each instrument manipulator assembly includes an instrument manipulatorinterface on a distal face of the instrument manipulator assembly, inone aspect. Each instrument manipulator assembly also includes aplurality of motors that drive elements of an instrument attached to theinstrument manipulator interface.

In one aspect, instrument manipulator positioning system 231A includes alateral motion mechanism. The lateral motion mechanism is coupled toeach of the movable platforms, i.e., coupled to each of the plurality ofinstrument manipulator assemblies, e.g., instrument manipulator assembly240A1 and instrument manipulator assembly 240A2. The lateral motionmechanism moves the plurality of instrument manipulator assemblies inplane 286B, i.e., the lateral motion mechanism moves an instrumentmanipulator assembly in a plane that is perpendicular to the directionof motion, as represented by arrow 290, provided by a longitudinalmotion mechanism. Various examples of the lateral motion mechanism aredescribed below. Thus, a lateral motion mechanism causes an instrumentmount interface to be moved laterally, i.e., in a directionperpendicular to extended lengthwise axis 285A, sometimes referred to aslengthwise axis 285A, of entry guide 270A. In one aspect, the lateralmotion is motion in a plane perpendicular to extended lengthwise axis285A.

FIG. 2C is a schematic side view that illustrates aspects of a surgicalsystem 200C that uses aspects of instruments, surgical deviceassemblies, and manipulation and control systems described herein. Thethree main components are an endoscopic imaging system 292, a surgeon'sconsole 294 (master), and a patient side support system 210C (slave),all interconnected by wired (electrical or optical) or wirelessconnections 296. One or more electronic data processors may be variouslylocated in these main components to provide system functionality.Examples are disclosed in U.S. patent application Ser. No. 11/762,165,which is incorporated by reference herein.

Patient side support system 210C includes an entry guide manipulator230C. At least one surgical device assembly is coupled to entry guidemanipulator 230C. Each surgical device assembly includes either asurgical instrument or a camera instrument. For example, in FIG. 2C, onesurgical device assembly includes an instrument 260C1 with a shaft 262C2that extends through entry guide 270C during a surgical procedure.

Entry guide manipulator 230C includes, as described more completelybelow, an instrument manipulator positioning system 231C, sometimesreferred to as positioning system 231C or system 231C. Positioningsystem 231C moves a portion of each of the instrument mount interfacesin a plane so that when each of the instruments is coupled to entryguide manipulator 230C using the instrument mount interfaces, each ofthe shafts of the instruments is aligned for insertion into one of thechannels in entry guide 270C. Typically, entry guide 270C includes aplurality of channels. Thus, instrument manipulator positioning system231C effectively moves the shafts of the instruments by moving eachinstrument in a plurality of instruments, as needed, to align each ofthe shafts for entry into a channel in a particular entry guide channelconfiguration.

Thus, in one aspect, an instrument mount interface is moved so that whenan instrument is attached to that instrument mount interface, a shaft ofthe instrument is properly aligned with a channel in an entry guide usedin the surgical procedure. In another aspect, the instrument is mountedon the instrument mount interface, and then the instrument mountinterface is moved. The movement of the instrument mount interfacesmoves the entire instrument so that the shaft of the instrument isproperly aligned with the channel in the entry guide used in thesurgical procedure. Consequently, the movement of the instrument mountinterface is the same irrespective of whether the instrument is mountedbefore or after the movement of the instrument mount interface.

In one aspect, positioning elements of instrument manipulatorpositioning system 231C, e.g., positioning elements of a lateral motionmechanism of system 231C, move in a plane to simultaneously move theinstrument mount interfaces and consequently move each instrument to theappropriate location for entry of that instrument's shaft into entryguide 270C. The path of the movement in the plane, sometimes called atrajectory, can be, for example, an arc, a straight line, a meanderingcombination of arcs, or some combination of curved paths and lines.Thus, the trajectory can have either one degree of freedom or twodegrees of freedom. The plane is perpendicular to the lengthwise axis ofentry guide 270C, in one aspect. Thus, in this aspect, each of thetrajectories is in a plane perpendicular to the lengthwise axis,sometimes referred to as the longitudinal axis, of entry guide 270C SeeFIG. 2D for examples of typical trajectories 226, 227, 228, and 229.

As a positioning element moves along a trajectory, the instrument mountinterface is moved along the same trajectory, and effectively a distaltip of a shaft of an instrument coupled to the instrument mountinterface moves along the same trajectory. Thus, motion of thepositioning element causes the shaft to be moved to a location where theshaft is aligned with a channel in entry guide 270C. In this position,the shaft can enter and pass through the channel in entry guide 270Cwithout damaging the instrument and without inhibiting operation of theinstrument. The particular paths implemented in instrument manipulatorpositioning system 231C depend at least in part on the types of surgicaldevice assemblies that can be mounted on system 231C and/or theconfiguration of channels in entry guide 270C.

As explained more completely below, different entry guides are used indifferent surgical procedures. An entry guide that enters the bodythrough the ribs typically has a different shape than an entry guidethat enters the body through an incision in the abdomen. The differentshapes of the entry guides require different layouts of the channelsthat extend through the entry guides, i.e., different channelconfigurations.

Also, the shapes and/or sizes of the shafts of the instruments may bedifferent for different instruments. An entry guide is used thataccommodates the shapes and sizes of the shafts of the instruments usedin a particular surgical procedure. The trajectories, such as thoseillustrated in FIG. 2D, are designed to accommodate a set of entryguides that can be used with patent side support system 210C.

When an entry guide, such as entry guide 270C, is mounted on entry guidemanipulator 230C, and an instrument, e.g., instrument 260C1, is mountedon entry guide manipulator 230C, a control system determines whethershaft 262C1 of instrument 260C1 can be, or has been, aligned byinstrument manipulator positioning system 231C with a channel in entryguide 270C. If instrument manipulator positioning system 231C cannotproperly align shaft 262C1, an alarm is activated and the system rejectsinstrument 260C1.

Instrument manipulator positioning system 231C can properly align shaft262C1 if system 231C can move the instrument mount interface andconsequently the entire surgical device assembly to a location so thatwhen shaft 262C1 passes through the corresponding channel in entry guide270C, instrument 260C1 is not damaged. Typically, instrument 260C1 notbeing damaged means that shaft 262C1 is not bent to the point that theshaft is damaged, e.g., permanently bent, and/or that operation ofelements passing though shaft 262C1 is not hindered during operation ofinstrument 260C1.

In one aspect, at least one of the surgical device assemblies inplurality of surgical device assemblies 280C includes a shaft with aportion that is rigid, but this rigid portion can be resiliently bentbetween entry guide 270C and the proximal end of the shaft. Arrow 290defines the distal and proximal directions. In one aspect, each surgicaldevice assembly in plurality of surgical device assemblies 280C ispositioned by instrument manipulator positioning system 231C to maintainthe bending stress or stresses on the instrument shaft within apredetermined stress profile. This assures that the instrument shaft andthus the instrument is not damaged by the bending, e.g., the stress onthe shaft is controlled such that the shaft does not yield andpermanently change shape. Additionally, the stress is maintained so thatas the shaft rolls in entry guide 270C, the cycling stress does notfatigue and break the shaft.

The ability to individually position an instrument, and hence its shaft,with respect to a channel in an entry guide by moving an instrumentmount interface provides versatility to patient side support system210C. For example, this ability allows entry guides with differentchannel configurations to be used in system 210C. In addition, theinstrument manipulator positioning system eliminates the need forsurgical procedure specific instruments. In other words, the instrumentmanipulator positioning system allows use of a common set of instrumentswith a variety of entry guides by moving the instrument shafts around,as described herein.

Prior to considering entry guide manipulator 230C with instrumentmanipulator positioning system 231C in further detail, other aspects ofsystem 200C are described. Imaging system 292 performs image processingfunctions on, e.g., captured endoscopic imaging data of the surgicalsite and/or preoperative or real time image data from other imagingsystems external to the patient. Imaging system 292 outputs processedimage data (e.g., images of the surgical site, as well as relevantcontrol and patient information) to a surgeon at surgeon's console 294.In some aspects, the processed image data is output to an optionalexternal monitor visible to other operating room personnel or to one ormore locations remote from the operating room (e.g., a surgeon atanother location may monitor the video; live feed video may be used fortraining; etc.).

Surgeon's console 294 includes multiple degrees-of-freedom (“DOF”)mechanical input devices (“masters”) that allow the surgeon tomanipulate the instruments, entry guide(s), and imaging system devices,which are collectively referred to as slaves. These input devices may insome aspects provide haptic feedback from the instruments and surgicaldevice assembly components to the surgeon. Console 294 also includes astereoscopic video output display positioned such that images on thedisplay are generally focused at a distance that corresponds to thesurgeon's hands working behind/below the display screen. These aspectsare discussed more fully in U.S. Pat. No. 6,671,581, which isincorporated by reference herein.

Control during insertion of the instruments may be accomplished, forexample, by the surgeon moving the instruments presented in the imagewith one or both of the masters; the surgeon uses the masters to movethe instrument in the image side to side and to pull the instrumenttowards the surgeon. The motion of the masters commands the imagingsystem and an associated surgical device assembly to steer towards afixed center point on the output display and to advance inside thepatient. In one aspect, the camera control is designed to give theimpression that the masters are fixed to the image so that the imagemoves in the same direction that the master handles are moved. Thisdesign causes the masters to be in the correct location to control theinstruments when the surgeon exits from camera control, and consequentlythis design avoids the need to clutch (disengage), move, and declutch(engage) the masters back into position prior to beginning or resuminginstrument control. In some aspects the master position may be madeproportional to the insertion velocity to avoid using a large masterworkspace. Alternatively, the surgeon may clutch and declutch themasters to use a ratcheting action for insertion. In some aspects,insertion may be controlled manually (e.g., by hand operated wheels),and automated insertion (e.g., servomotor driven rollers) is then donewhen the distal end of the surgical device assembly is near the surgicalsite. Preoperative or real time image data (e.g., MRI, X-ray) of thepatient's anatomical structures and spaces available for insertiontrajectories may be used to assist insertion.

Patient side support system 210C includes a floor-mounted base 201C, oralternately a ceiling mounted base (not shown). Base 201C may be movableor fixed (e.g., to the floor, ceiling, wall, or other equipment such asan operating table).

Base 201C supports an arm assembly that includes a passive, uncontrolledsetup arm assembly 220C and an actively controlled manipulator armassembly 230C. The actively controlled manipulator arm assembly 230C isreferred to as entry guide manipulator 230C.

In one example, the setup portion includes a first setup link 202C andtwo passive rotational setup joints 203C and 205C. Rotational setupjoints 203C and 205C allow manual positioning of the coupled setup links204C and 206C if the joint brakes for setup joints 203C and 205C arereleased. Alternatively, some of these setup joints may be activelycontrolled, and more or fewer setup joints may be used in variousconfigurations. Setup joints 203C and 205C and setup links 204C and 206Callow a person to place entry guide manipulator 230C at variouspositions and orientations in Cartesian x, y, z space. A passiveprismatic setup joint (not shown) between link 202C of arm assembly 220Cand base 201C may be used for large vertical adjustments 212C.

Remote center of motion 246C is the location at which yaw, pitch, androll axes intersect (i.e., the location at which the kinematic chainremains effectively stationary while joints move through their range ofmotion). As described in more detail below, some of these activelycontrolled joints are manipulators that are associated with controllingDOFs of individual instruments, and others of these actively controlledjoints are associated with controlling DOFs of a single assembly ofthese manipulators. The active joints and links are movable by motors orother actuators and receive movement control signals that are associatedwith master arm movements at surgeon's console 294.

As shown in FIG. 2C, a manipulator assembly yaw joint 211C is coupledbetween an end of setup link 206C and a first end, e.g., a proximal end,of a first manipulator link 213C. Yaw joint 211C allows firstmanipulator link 213C to move with reference to link 206C in a motionthat may be arbitrarily defined as “yaw” around a manipulator assemblyyaw axis 223C. As shown, the rotational axis of yaw joint 211C isaligned with a remote center of motion 246C, which is generally theposition at which an instrument enters the patient (e.g., at theumbilicus for abdominal surgery).

In one embodiment, setup link 206C is rotatable in a horizontal or x, yplane and yaw joint 211C is configured to allow first manipulator link213C in entry guide manipulator 230C to rotate about yaw axis 223C.Setup link 206C, yaw joint 211C, and first manipulator link 213C providea constantly vertical yaw axis 223 for entry guide manipulator 230C, asillustrated by the vertical line through yaw joint 211C to remote centerof motion 246C.

A distal end of first manipulator link 213C is coupled to a proximal endof a second manipulator link 215C by a first actively controlledrotational joint 214C. A distal end of second manipulator link 215C iscoupled to a proximal end of a third manipulator link 217C by a secondactively controlled rotational joint 216C. A distal end of thirdmanipulator link 217C is coupled to a distal portion of a fourthmanipulator link 219C by a third actively controlled rotational joint218C.

In one embodiment, links 215C, 217C, and 219C are coupled together toact as a coupled motion mechanism. Coupled motion mechanisms are wellknown (e.g., such mechanisms are known as parallel motion linkages wheninput and output link motions are kept parallel to each other). Forexample, if rotational joint 214C is actively rotated, then joints 216Cand 218C are also actively rotated so that link 219C moves with aconstant relationship to link 215C. Therefore, it can be seen that therotational axes of joints 214C, 216C, and 218C are parallel. When theseaxes are perpendicular to rotational axis 223 of joint 211C, links 215C,217C, and 219C move with reference to link 213C in a motion that may bearbitrarily defined as “pitch” around a manipulator assembly pitch axis.The manipulator pitch axis extends into and out of the page in FIG. 2Cat remote center of motion 246C in this aspect. The motion around themanipulator assembly pitch axis is represented by arrow 221C. Sincelinks 215C, 217C, and 219C move as a single assembly in this embodiment,first manipulator link 213C may be considered an active proximalmanipulator link, and second through fourth manipulator links 215C,217C, and 219C may be considered collectively an active distalmanipulator link.

An entry guide manipulator assembly platform 232C, sometimes referred toas platform 232C, is coupled to a distal end of fourth manipulator link219C. An entry guide manipulator assembly 233C is rotatably mounted onplatform 232C. Entry guide manipulator assembly 233C includes instrumentmanipulator positioning system 231C.

Each of plurality of surgical device assemblies 280C is coupled to entryguide manipulator assembly 233C by an insertion assembly 235C. Entryguide manipulator assembly 233C rotates plurality of surgical deviceassemblies 280C as a group around axis 225C. Specifically, entry guidemanipulator assembly 233C rotates as a single unit with reference toplatform 232C in a motion that may be arbitrarily defined as “roll”around an entry guide manipulator assembly roll axis 225C.

For minimally invasive surgery, the instruments must remainsubstantially stationary with respect to the location at which theinstruments enter the patient's body, either at an incision or at anatural orifice, to avoid unnecessary tissue damage. Accordingly, theyaw and pitch motions of the instruments should be centered around asingle location on manipulator assembly roll axis 225C that staysrelatively stationary in space. This location is referred to as remotecenter of motion 246C.

For single port surgery, in which all the instruments (including acamera instrument) must enter via a single small incision (e.g., at theumbilicus) or natural orifice, all instruments must move with referenceto such a generally stationary remote center of motion 246C. Therefore,remote center of motion 246C of entry guide manipulator 230C is definedby the intersection of manipulator assembly yaw axis 223C andmanipulator assembly pitch axis 221C. The configuration of links 215C,217C, and 219C, and the configuration of joints 214C, 216C, and 218C aresuch that remote center of motion 246C is located distal of entry guidemanipulator assembly 233C with sufficient distance to allow entry guidemanipulator assembly 233C to move freely with respect to the patient.Manipulator assembly roll axis 225C also intersects remote center ofmotion 246C.

Cannula 275C is removably coupled to a cannula mount, which in oneembodiment is coupled to the distal end 219C_P of fourth manipulatorlink 219C. In one implementation, the cannula mount is coupled to link219C by a rotational joint that allows the mount to move between astowed position adjacent link 219C and an operational position thatholds the cannula in the correct position so that remote center ofmotion 246C is located along the cannula. During operation, the cannulamount is fixed in position relative to link 219C according to oneaspect.

In this description, a cannula is typically used to prevent aninstrument or an entry guide from rubbing on patient tissue. Cannulasmay be used for both incisions and natural orifices. For situations inwhich an instrument or an entry guide does not frequently translate orrotate relative to its insertion (longitudinal) axis, a cannula may notbe used. For situations that require insufflation, the cannula mayinclude a seal to prevent excess insufflation gas leakage past theinstrument or entry guide. Examples of cannula assemblies which supportinsufflation and procedures requiring insufflation gas at the surgicalsite may be found in U.S. patent application Ser. No. 12/705,439 (filedFeb. 12, 2010; disclosing “Entry Guide for Multiple Instruments in aSingle Port System”), the full disclosure of which is incorporated byreference herein for all purposes. For thoracic surgery that does notrequire insufflation, the cannula seal may be omitted, and ifinstruments or entry guide insertion axis movement is minimal, then thecannula itself may be omitted. A rigid entry guide may function as acannula in some configurations for instruments that are insertedrelative to the entry guide. Cannulas and entry guides may be, e.g.,steel or extruded plastic. Plastic, which is less expensive than steel,may be suitable for one-time use.

The various passive setup joints/links and active joints/links allowpositioning of the instrument manipulators to move the instruments andimaging system with a large range of motion when a patient is placed invarious positions on a movable table. In some embodiments, a cannulamount may be coupled to the proximal link or first manipulator link213C.

Certain setup and active joints and links in the manipulator arm may beomitted to reduce the surgical system's size and shape, or joints andlinks may be added to increase degrees of freedom. It should beunderstood that the manipulator arm may include various combinations oflinks, passive joints, and active joints (redundant DOFs may beprovided) to achieve a necessary range of poses for surgery.Furthermore, various instruments alone or surgical device assembliesincluding entry guides, multiple instruments, and/or multiple entryguides, and instruments coupled to instrument manipulators (e.g.,actuator assemblies) via various configurations (e.g., on a proximalface or a distal face of the instrument transmission means or theinstrument manipulator), are applicable in aspects of the presentdisclosure.

Each of plurality of surgical device assemblies 280C includes aninstrument manipulator assembly and one of a surgical instrument and acamera assembly. In FIG. 2C, two of a plurality of surgical deviceassemblies 280C are visible, and each of the two visible surgical deviceassemblies includes an instrument manipulator assembly and aninstrument. Each of instrument manipulator assemblies 240C1 and 240C2 isteleoperated, in one aspect, and so each is sometimes referred to as ateleoperated instrument manipulator assembly. Each of instrumentmanipulator assemblies 240C1, 240C2 is coupled to entry guidemanipulator assembly 233C by an different insertion assembly, e.g.instrument manipulator assembly 240C1 is coupled to entry guidemanipulator assembly by insertion assembly 235C.

In one aspect, insertion assembly 235C is a telescoping assembly thatmoves the corresponding surgical device assembly away from and towardsentry guide manipulator assembly 235C. In FIG. 2C, insertion assembly235C is in the fully retracted position.

Each instrument manipulator assembly 240C1, 240C2 includes a pluralityof motors that drive a plurality of outputs in an output interface ofinstrument manipulator assembly 240C1, 240C1. Each of instruments 260C1,260C2 includes a body that houses a transmission unit. The transmissionunit includes an input interface including a plurality of inputs. Eachof instruments 260C1, 260C2 also includes a shaft 262C1, 262C2 sometimesreferred to as a main tube that extends in the distal direction from thebody. An end effector 263C is coupled to a distal end of the shaft. SeeU.S. Patent Application No. 61/866,115 (filed on 15 Aug. 2013), which isincorporated by reference, for one example of an instrument manipulatorassembly and a surgical instrument.

Each of instruments 260C1, 260C2 is coupled to the instrument mountinterface of a corresponding instrument manipulator assembly 240C1,240C2 so that a plurality of inputs in an input interface of thetransmission unit in instrument 260C1, 260C2 are driven by plurality ofoutputs in the instrument mount interface of instrument manipulatorassembly 240C1, 240C2. See U.S. Patent Application No. 61/866,115 (filedon 15 Aug. 2013).

In one aspect, a membrane interface that is part of a sterile surgicaldrape may be placed between the instrument mount interface of instrumentmanipulator assembly 240C and the input interface of the transmissionunit in instrument 260C. See, for example, U.S. Patent ApplicationPublication No. US 2011/0277776 A1 for an example of the membraneinterface and sterile surgical drape. In another aspect, a sterileadapter that is part of a sterile surgical drape may be placed betweenthe instrument mount interface of instrument manipulator assembly 240Cand the input interface of the transmission unit in instrument 260C.See, for example, U.S. Patent Application Publication No. US2011/0277775 A1 for an example of a sterile adapter and a sterilesurgical drape.

In one aspect, one or more instrument manipulator assemblies may beconfigured to support and actuate a particular type of instrument, suchas a camera instrument. As shown in FIG. 2C, the shafts of plurality ofsurgical device assemblies 280C extend distally from a body of theinstruments. The shafts extend through a common cannula 275C placed atthe entry port into the patient (e.g., through the body wall or at anatural orifice). In one aspect, an entry guide 270C is positionedwithin cannula 275C, and each instrument shaft extends through a channelin entry guide 270C, so as to provide additional support for theinstrument shafts.

The surgeries that can be performed using surgical system 200C may beperformed on different regions of the body. For example, one surgery maybe performed through the mouth of a patient. Another surgery may beperformed between the ribs of the patient. Other surgeries may beperformed through other orifices of the patient or through an incisionin the patient. Each different entry into a patient may require adifferent shape and/or different size of an entry guide. Thus, anappropriate guide 270C is selected for a particular surgery.

An entry guide, which is suitable for abdominal surgery, may not besuitable for surgery through the mouth or between the ribs. The size andshape of an entry guide limits the locations of channels through theentry guide for shafts 262C1, 262C2 of plurality of surgical deviceassemblies 280C. Thus, instrument manipulator positioning system 231Cmoves each of instrument manipulator assemblies 240C1, 240C2 andcorresponding instrument 260C1, 260C2 so that each of shafts 262C1,262C2 is properly aligned for entry into a different channel of entryguide 270C. In one aspect, instrument manipulator positioning system231C moves each of instrument manipulator assemblies 240C1, 240C2 andcorresponding instrument 260C1, 260C2 to align shaft 262C1, 262C2 sothat any bend in shaft 262C1, 262C2 between a proximal end of the shaftand a point of contact of the shaft with entry guide 270C as the shaftpasses through entry guide 270C does not damage the instrument and doesnot inhibit operation of the instrument. Thus, not only is system 200Cconfigured to use a variety of instruments, but also system 200C isconfigured to use a variety of different entry guides. Variouscombinations of these different entry guides are provided in kits.

FIG. 2D is an illustration of example paths 226 to 229 along which adifferent one of plurality of surgical device assemblies 280C can bemoved by instrument manipulator positioning system 231C. In thisexample, three of the paths 227 to 229 are curved paths and one of thepaths 226 is a linear path. In one aspect, linear path 226 is used for acamera instrument and the three curved paths 227 to 229 are used forsurgical instruments. Each entry guide that can be used with system 200Chas a channel positioned so that a surgical device assembly positionedon one of the four paths can pass the shaft of that surgical deviceassembly through that channel and work correctly for that instrument'sintended purpose. In one aspect, instrument manipulator positioningsystem 231C automatically moves each of the entire surgical deviceassemblies to the appropriate location on the path for the entry guidebeing used in system 200C. In another aspect, each of the entiresurgical device assemblies is manually moved to the appropriate locationon the path for the entry guide being used in system 200C.

FIG. 2E is an illustration of one implementation 210E of patient sidesupport system 210C. In this aspect, patient side support system 210E isimplemented as a patient-side cart 210E having a passive setup arm 220Eand entry guide manipulator 230E. Entry guide manipulator 230E supportsa plurality of surgical device assemblies.

In one aspect, at least one of the plurality of surgical deviceassemblies includes an instrument manipulator assembly 240E, a sterileadapter assembly 250E, and an instrument 260E. A main tube, sometimesreferred to as a shaft, of instrument 260E extends through a channel inentry guide 270E during a surgical procedure.

The use of instrument manipulator assembly 240E and sterile adapterassembly 250E to couple instrument 260E to entry guide manipulator 230Eis illustrative only and is not intended to be limiting. Instrument 260Ecan be coupled to entry guide manipulator in other ways so thatinstrument manipulator positioning system 231E can align shaft 262E withthe corresponding channel in entry guide 270E for entry of shaft 262Einto that channel.

Entry guide 270E is movably mounted in cannula 275E. Entry guide 270Emay maintain an insufflation seal, if necessary, and entry guide 270Esupports the shafts of the instruments at the entry into the body ofpatient 299. As explained more completely below, a plurality ofdifferent entry guides can be mounted and used in patient side supportsystem 210E. Typically, a different entry guide is used for eachdifferent type of surgery.

The different surgeries that can be performed using patient side supportsystem 210E may be performed on different regions of the body. Forexample, one surgery may be performed through the mouth of patient 299.Another surgery may be performed between the ribs of patient 299. Othersurgeries may be performed through other orifices of patient 299. Entryguide 270E, which is suitable for abdominal surgery, may not be suitablefor surgery through the mouth or between the ribs. A different shapedentry guide may be required for surgery through the mouth or between theribs.

Not only is patient side support system 210E configured to use a varietyof instruments, but also system 210E is configured to use a variety ofdifferent entry guides. Various combinations of these different entryguides are provided in kits.

When a rib entry guide for a surgery between the ribs is substituted forentry guide 270E, the channel configuration of the rib entry guide isdifferent from the channel configuration of entry guide 270E, e.g., thelayout of the channels relative to each other is different in the twoentry guides. Also, one or more different surgical device assemblies maybe mounted on entry guide manipulator 230E after the surgery using entryguide 270E is completed and the rib entry guide is mounted in patientside system 201E. Thus, the positions of the shafts of the surgicaldevice assemblies are unlikely to be properly aligned for insertion intothe rib entry guide. To correct this problem, entry guide manipulator230E includes an instrument manipulator positioning system 231E.Instrument manipulator positioning system 231E simultaneously positionsinstrument mount interfaces for the surgical device assemblies withrespect to the channels in the rib entry guide so that when a surgicaldevice assembly is mounted on each of the instrument mount interfaceseach instrument shaft is not damaged as the shaft passes through thecorresponding channel in rib entry guide. This is done with little or nouser input in some aspects.

Returning to the configuration illustrated in FIG. 2E, the plurality ofsurgical device assemblies mounted on entry guide manipulator 230E isspaced closely together. To permit this close packing arrangement and topermit the channels in entry guide 270E to be close together, in oneaspect, the shafts of the instruments are angled from the instrumenthousings (See FIG. 4B) and in some aspects bent against entry guide 270Eas the shafts pass through cannula 275E. As just described, instrumentmanipulator positioning system 231E simultaneously positions each of theentire surgical device assemblies, as needed, with respect to acorresponding channel in entry guide 270E so that each instrument shaftis not damaged as the shaft passes through the corresponding channel inentry guide 270E. Again, this is done with little or no user input, inone aspect.

In one aspect, instrument manipulator positioning system 231E limits thenumber of actuators and sensors required. Instrument manipulatorpositioning system 231E is synchronized with a roll system in entryguide manipulator 230E. The roll system rolls the surgical deviceassemblies as a group. In one aspect, gearing is used in instrumentmanipulator positioning system 231E to align the shafts of the surgicaldevice assemblies for insertion into entry guide 270E and to maintainthe synchronization.

To further simplify the design and the size of instrument manipulatorpositioning system 231E, in one aspect, the motion of instrumentmanipulator positioning system 231E used to align each of the pluralityof instrument shafts with respect to the corresponding channels in entryguide 270E is limited to one degree of freedom in one aspect, and islimited to two degrees of freedom in another aspect. Irrespective of thenumber of degrees of freedom, the motion is in a plane. In addition, therange of motion of each of the plurality of surgical device assembliesis limited to the extent possible so that the range of motion of theplurality of surgical device assemblies does not compete for space thatmight otherwise be used for drape management, electronics, and reducingthe overall size of system 210E.

Hence, as explained more completely below, entry guide manipulator 230Epositions each entire surgical device assembly so that the shaft of thesurgical device assembly is aligned for entry in the correspondingchannel of entry guide 270E for that particular surgical deviceassembly. If the shaft is bent upon passing through entry guide 270E,the shaft is aligned so that any bending does not damage the instrumentand does not inhibit operation of the instrument. This simultaneousautomatic alignment of the instrument shafts is done for each entryguide that is used in system 210E.

In one aspect, a control system automatically checks on thecompatibility of the surgical device assemblies mounted on entry guidemanipulator 230E with the channel locations in entry guide 270E. In someinstances, it is necessary to flex, e.g., slightly bend, the shaft ofthe instrument to insert the shaft in the appropriate channel in entryguide 270E. If this flex will damage the instrument, an alarm is issuedby the control system when the instrument is mounted in system 210E andthe system rejects use of that instrument. When a shaft of an instrumentis flexed so that the resulting stresses are outside an allowable stressprofile, the shaft may be damaged, e.g., permanently bent, andconsequently the tendons that run through the shaft may not operateproperly.

If the instrument is compatible with the entry guide, the control systemchecks other elements of the surgical system for compatibility with theentry guide, e.g., drapes, cameras, foot pedal control assemblies,master control assemblies, etc. Finally, the control system makes anyneeded adjustments in the user interface elements, allowable controlmodes, type and behavior of control modes, etc. for both the surgeon andpatient side assistant based on the entry guide configuration. Forexample, if the entry guide is used in ear, throat, and nose surgery,the configuration and allowable range of motion of the variousinstruments would be different from entry guide 270E that is used forabdominal surgery, and so the control system automatically makes thenecessary changes based on the entry guide to be used in the procedure.

As explained more completely below, in one aspect, each instrument 260Eis positioned by entry guide manipulator 230E to maintain the bendingstress or stresses on the instrument shaft within a predetermined stressprofile. This assures that the bending does not damage the instrumentand that the bending does not affect the correct operation of theinstrument. For each entry guide with a different channel configuration,entry guide manipulator 230E positions each instrument so that thebending stress or stresses on the instrument shaft remains within thepredetermined stress profile.

In FIG. 2E, elements 202E, 203E, 204E, 205E, 206E, and 211E of passivesetup arm 220E are equivalent to elements 202C, 203C, 204C, 205C, 206C,and 211C of passive setup arm 220C. Thus, the description of passivesetup arm 220C is applicable to passive setup 220E, and so is notrepeated here. Elements 213E, 214E, 215E, 216E, 217E, 218E and 219E ofentry guide manipulator 230E are equivalent to elements 213C, 214C,215C, 216C, 217C, 218C and 219C of entry guide manipulator 230C. Thus,the description of elements 213C, 214C, 215C, 216C, 217C, 218C and 219Cof entry guide manipulator 230C is applicable to elements 213E, 214E,215E, 216E, 217E, 218E and 219E of entry guide manipulator 230E, and sois not repeated here. Similarly, base 201E is equivalent to base 201C.

Entry guide manipulator 230E changes the pitch around axis 221E of theplurality of surgical device assemblies as a group. Entry guidemanipulator 230E changes the yaw around axis 223E of the plurality ofsurgical device assemblies as a group. In one aspect, entry guidemanipulator 230E also rolls the plurality of surgical device assembliesas a group about a roll axis 225E. Roll axis 225E, in this aspect, iscoincident with a longitudinal axis of cannula 275E. Pitch axis 221E,yaw axis 223E, and roll axis 225E intersect at remote center of motion246E. Remote center of motion 246E is located along cannula 275E.

While it not shown in FIG. 2E, the surgical system also includes acontrol system and a master control console equivalent to thosedescribed with respect to FIG. 2C. In FIG. 2E, the surgery is in theabdomen of patient 299. However, the surgical system including patientside support system 210E is used for a wide variety of surgeries. Thevariety of surgical procedures uses various combinations of instruments.

For convenience, the instruments, in one aspect, are grouped into setsof instruments based on the shaft characteristics of the instruments,e.g., standard surgical instrument, advanced surgical instruments, andcamera instruments, as explained more completely below. Briefly, theshafts of the advanced surgical instruments have a larger diameter thanthe diameter of the standard surgical instruments. The grouping of theinstruments is for ease of discussion and the names of the groups arenot intended to limit the instruments to any specific surgicalinstruments. In some surgeries, a manual instrument or instruments maybe used in conjunction with teleoperated surgical instruments. A manualinstrument is an instrument that a person controls using a handle orgrip of the instrument itself.

The shaft of a camera instrument has a fixed bend. In one aspect, twodifferent camera instruments are provided. One of the camera instrumentshas the fixed bend at a first location in a shaft of the camerainstrument and the other of the camera instruments has the fixed bend inat a second location in a shaft of that camera instrument. The first andsecond locations are different locations.

FIGS. 3A and 3B are illustrations of a plurality of surgical deviceassemblies 300 mounted on entry guide manipulator 230E. As noted above,each of the plurality of surgical device assemblies 300 includes aninstrument manipulator assembly 240_1, a sterile adapter assembly 250_1,and an instrument 260_1. In FIG. 3A, each of the plurality of surgicaldevice assemblies 300 is positioned at an initial position on aninsertion assembly 331. Insertion assembly 331 is an example of alongitudinal motion mechanism. In FIG. 3B, three of the four surgicaldevice assemblies have been moved distally on the insertion assembly.Arrow 390 defines the distal and proximal directions. Here, the distaldirection is towards patient 299. The proximal direction is away frompatient 299.

The proximal end of each insertion assembly in FIGS. 3A and 3B is shownas floating. As explained more completely below, in one aspect, theproximal end of each insertion assembly is mounted on a movableplatform. The movable platform is coupled to instrument manipulatorpositioning system 231E in entry guide manipulator 230E. The movableplatform allows the lateral motion mechanism of entry guide manipulator230E to move the movable platform in a plane perpendicular to thelongitudinal axis of entry guide 270, and consequently the entiresurgical device assembly, so that the shaft of the instrument attachedto the movable platform can be inserted in the corresponding channel ofentry guide 270 without damaging the shaft, e.g., without exceeding thelimits on the bending stresses. Once the instrument is properlypositioned by instrument manipulator positioning system 231E, themovable platform is locked in place.

FIGS. 3A and 3B illustrate the configuration that is used as an examplein the following description. Instrument 260_0 is a camera instrument.Instruments 260_1 to 260_3 are standard or advanced surgicalinstruments. Instrument 260_1 is referred to as a first surgicalinstrument, instrument 260_2 as a second surgical instrument, andinstrument 260_3 as a third surgical instrument. Thus, the camerainstrument is mounted roughly at the twelve o'clock position on a clock;the first surgical instrument is mounted roughly at the three o'clockposition, and so on. The first, second, and third surgical instrumentsmay be instruments of the same type, or instruments of different types.The types of the surgical instruments are selected for compatibilitywith the channel sizes in the entry guide, as explained more completelybelow.

As illustrated in FIG. 3B, each insertion assembly includes threecomponents. Using insertion assembly 331_1 as an example, insertionassembly 331_1 includes a frame 331A_1, a mid-carriage 331B_1, and adistal carriage 331C_1. Mid-carriage 331B_1 rides on a ball screw inframe 331A_1. In one aspect, the ball screw has a 6 mm pitch, and so theball screw is back-drivable. Mid-carriage 331B_1 includes metal beltsthat drive distal carriage 331C_1. Distal carriage 331C_1 is attached tosurgical device assembly 300 that includes surgical instrument 260_1.

Thus, as described more completely below, when a positioning element ininstrument manipulator positioning system 231E moves the movableplatform affixed to the proximal end of frame 331A_1, insertion assembly331_1 and the surgical device assembly of plurality of surgical deviceassemblies 300 including surgical instrument 260_1 and its shaft are allmoved as a single unit. Thus, the movement of the positioning element ininstrument manipulator positioning system 231E moves insertion assembly331_1 and entire surgical device assembly 300 including surgicalinstrument 260_1 and its shaft along the same trajectory that thepositioning element follows.

Prior to considering the positioning of the instrument in plurality ofsurgical device assemblies 300 in further detail, one aspect of asurgical device assembly is described. FIGS. 4A and 4B are a moredetailed illustration of one aspect of a surgical device assembly inplurality of surgical device assemblies 300.

A base assembly 432 (FIG. 4A) is connected to a rotatable base in entryguide manipulator 230E. Insertion assembly 331 is connected to afloating platform (not visible) in base assembly 432. There is anopening 433 in the distal end of base assembly 432 in which insertionassembly 331 can move about, as described more completely below.

In this example, the housing of base assembly 432 is roughly wedgeshaped (pie-shaped) to allow assembly 432 to be closely positioned tosimilar housings as illustrated in FIG. 2E. A vertex of the wedge shapeof each of the base assemblies of the four surgical device assemblies isarranged around an extended longitudinal axis of cannula 275E.

An instrument manipulator assembly 240 is affixed to insertion assembly331. Instrument manipulator assembly 240 is an example of the instrumentmanipulator assemblies illustrated in FIGS. 2A to 2C, 2E, 3A, and 3B.Instrument manipulator assembly 240 includes a plurality of drive units.

A sterile adapter assembly 250 is mounted on instrument manipulatorassembly 240. Sterile adapter assembly 250 is an example of the sterileadapter assemblies illustrated in FIGS. 2E, 3A, and 3B. Sterile adapterassembly 250 includes a plurality of intermediate disks. Eachintermediate disk is coupled to a drive disk on a drive unit ofinstrument manipulator assembly 240. Hence, in this example, theinstrument mount interface is provided by a combination of instrumentmanipulator assembly 240 and sterile adapter assembly 250. However, theinstrument mount interface could alternatively be defined as a distalface of sterile adapter assembly 250 mounted on instrument manipulatorassembly 240.

Sterile adapter assembly 250 includes a sterile drape (not shown).Sterile drapes are known and so are not described in further detail. Seefor example, U.S. Pat. No. 7,666,191 B2, U.S. Pat. No. 7,699,855 B2,U.S. Patent Application Publication No. US 2011/0277775 A1, and U.S.Patent Application Publication No. US 2011/0277776 A1, all of which areincorporated herein by reference. The sterile drape drapes at least aportion of system 210E to maintain a sterile field during a surgicalprocedure while sterile adapter assembly 250E also facilitates efficientand simple instrument exchange.

FIG. 4B is a more detailed illustration of an example of a surgicalinstrument 260. Surgical instrument 260 is an example of the surgicalinstruments illustrated in FIGS. 2A, 2C, 2E, 3A, and 3B. Surgicalinstrument 260, in this aspect, includes a driven interface assembly461, a transmission unit 465, a main tube 467, a parallel motionmechanism 468, a wrist 469, and an end effector 470. Wrist 469 isdescribed, for example, in U.S. Patent Application No. US 2003/0036478A1 (disclosing “Surgical Tool Having Positively PositionableTendon-Activated Multi-Disk Wrist Joint”), which is incorporated hereinby reference. Parallel motion mechanism 868 is described, for example,in U.S. Pat. No. 7,942,868 B2 (disclosing “Surgical Instrument WithParallel Motion Mechanism”), which also is incorporated herein byreference.

Driven interface assembly 461 includes a plurality of driven disks. Eachdriven disk is coupled to a corresponding intermediate disk in sterileadapter assembly 250 when surgical instrument 260 is mounted in sterileadapter 250, as illustrated in FIGS. 2D, 3A, and 3B.

Mechanical components (e.g., gears, levers, gimbals, cables etc.) intransmission unit 465 transfer forces from the driven disks to cables,wires, and/or cable, wire, and hypotube combinations that run throughmain tube 467 to control movement of parallel motion mechanism 468,wrist 469, and end effector 470. Main tube 467 has a bearing 471 at theproximal end of main tube 467.

Main tube 467 is substantially rigid, which means that main tube 467 canbe bent slightly between transmission unit 465 and entry guide 270E.This bending allows the channels in entry guide 270E to be spaced closertogether than the size of the base assemblies would otherwise allow. Thebending is resilient so that main tube 467 assumes its straight shapewhen surgical instrument 260E is withdrawn from entry guide 270E (themain tube may be formed with a permanent bend as in the camerainstrument). The allowable stress profile, mentioned above, is a stressprofile such that the bending remains resilient and main tube 467 is notpermanently deformed by the bending stresses.

Instrument manipulator assembly 240 (FIG. 4A) includes a radio-frequencyidentification (RFID) reader 445 in a distal end of instrumentmanipulator assembly 240. Surgical instrument 260 has an RFID tag 455mounted on a proximal end surface of instrument 260. When surgicalinstrument 260 is mounted in sterile adapter assembly 250, RFID tag 455is positioned under RFID reader 445. After surgical instrument 260 ismounted in sterile adapter assembly 250, the control system receives theinformation from RFID reader 445 and uses the information in identifyingsurgical instrument 260 to determine the compatibility of surgicalinstrument 260 with entry guide 270E.

FIG. 5A is a schematic representation of four base assemblies 432_0,432_1, 432_2, and 432_3 mounted on entry guide manipulator 230E. FIG. 5Ashows that four wedge-shaped assemblies 432_0, 432_1, 432_2, and 432_3form a circle 501. Center 501C of circle 501 is on the extendedlongitudinal axis of cannula 275E.

The use of wedge-shaped base assemblies is illustrative only and is notintended to be limiting. The base assemblies could have a square shape,a rectangular shape, or other shape so long as the base assemblies canbe mounted on entry guide manipulator 230E and then moved as a group inroll, pitch, and yaw by entry guide manipulator 230E. For example, inFIG. 5F, base assemblies having a hexagonal shape as shown in aconfiguration 590 that could be mounted on and moved by entry guidemanipulator 230E.

FIG. 5B is a cross sectional view of a first entry guide 570S that isreferred to as a standard entry guide 570S. Entry guide 570S is movably,e.g., rotatably, mounted in a cannula 580. Entry guide 570S has fourlumens that are referred to as channels. The channels extend from aproximal end of entry guide 570S to a distal end of entry guide 570S,e.g., the channels extend from a first end to a second end of the entryguide. This is true for each of the channels of an entry guide describedherein. In one aspect, entry guide 570S is entry guide 270E and cannula580 is cannula 275E.

In this aspect, one of the surgical device assemblies includes anendoscope and a camera. This instrument is referred to as a camerainstrument. The camera instrument has a pre-bent shaft. The bend in theshaft remains between the distal part of transmission unit 465 and theproximal end of entry guide 270E, e.g., the bend does not enter entryguide 270E. The cross-section of the portion of the camera shaft thatgoes through entry guide 270E and cannula 275E is an oblong shape, inone aspect. Alternatively, the cross-section of the portion of thecamera shaft that goes through entry guide 270E and cannula 275E couldhave a circular shape.

Thus, standard entry guide has a camera channel 571S with an oblongcross section, and three surgical instrument channels 572S1, 572S2,572S3 that are circular in cross section. In this aspect, each of thethree surgical instrument channels 572S1, 572S2, 572S3 is the same size,e.g., has the same diameter. The diameter is selected such that asheathed shaft of a surgical instrument can be passed through thechannel. Surgical instrument channels 572S1, 572S2, 572S3 are referredto as standard surgical instrument channels.

In FIG. 5A, a channel in standard entry guide 570S that is associatedwith a particular base assembly 432_0, 432_1, 432_2, and 432_3 is shownas a dotted line. A channel being associated with a base assembly meansthat the shaft of the surgical instrument mounted on that base assemblyis inserted through the channel. For example, surgical instrument 260_2is mounted on base assembly 432_2 and shaft 467 passes through channel572S2. Thus, both base assembly 432_2 and surgical instrument 260_2 areassociated with channel 572S2.

FIG. 5C is a cross sectional view of a second entry guide 570MS. Entryguide 570MS is positioned in a cannula 581. Entry guide 570MS also hasfour lumens that are referred to as channels. Entry guide 570MS has anouter diameter that is larger than the outer diameter of standard entryguide 570S.

Entry guide 570MS has an oblong camera channel 571MS, and two standardcircular surgical instrument channels 572MS1 and 572MS3. In this aspect,entry guide 570MS also includes a manual instrument channel 573MS. Inone aspect, a manually controlled surgical instrument is passed throughchannel 573MS. In another aspect, a teleoperated surgical instrument ispassed through channel 573MS.

In FIG. 5D, an x-axis 590 and a y-axis 591 have an origin at a center ofentry guide 570MS. Entry guide 570S, which is represented by dashedlines, is overlaid on entry guide 570MS with its center also at theorigin. The center of entry guide 570MS in FIG. 5D represents alongitudinal axis of entry guide 570MS.

Assuming that entry guide 570MS is being used and the positioningelements for the surgical instruments attached to base assemblies 432_1and 432_3 are in the standard positions as shown in FIG. 5A, the shaftsof surgical instruments 260_1 and 260_3 (FIG. 3A) are not properlypositioned for insertion through channels 572MS1 and 572MS3. Instead,the shafts of surgical instruments 260_1 and 260_3 are positioned topass though channels 572S1 and 572S3 in standard entry guide 570S.Similarly, camera instrument 260_0 is positioned for channel 571S andnot channel 571MS.

In one aspect, instrument manipulator positioning system 231E in entryguide manipulator 230E moves a first positioning element that isassociated with surgical instrument 260_1 to a position indicated byarrow 581. Specifically, the movement of the positioning element iscoupled to surgical instrument 260_1, and so moves the shaft of surgicalinstrument 260_1 to the appropriate position to enable insertion of theshaft into channel 572MS1 without damaging the shaft.

Similarly, instrument manipulator positioning system 231E in entry guidemanipulator 230E moves a second positioning element that is associatedwith surgical instrument 260_3 to a position indicated by arrow 583. Theinstrument manipulator positioning system in entry guide manipulator230E also moves a third positioning element that is associated withcamera instrument 260_0 to a position indicated by arrow 580. In the newpositions, the shafts of the surgical instruments and the shaft of thecamera instrument are positioned to enable insertion through thecorresponding channels in entry guide 570MS. In one aspect, all of thepositioning elements are simultaneously moved to the correct location.In one aspect, the positioning elements are included in the lateralmotion mechanism of system 231E.

In FIG. 5E, the dotted lines represent a position of insertion assembly531 and a surgical device assembly 500 with a shaft 567 configured for afirst entry guide, e.g., entry guide 570S. If shaft 567 is withdrawnfrom entry guide 570S and a second entry guide such as entry guide 570MSis placed in the system, the position of shaft 567 as shown by thedotted line is not correct for entry into the corresponding channel inthe second entry guide (See FIG. 5D).

The solids lines in FIG. 5E illustrate the result of instrumentmanipulator positioning system 550 in entry guide manipulator 530 movingpositioning element 549 that is coupled to surgical device assembly 500.In particular, insertion assembly 531 is mounted on a floating platform532A that is connected to positioning element 549. As positioningelement 549 is moved by instrument manipulator positioning system 550,floating platform 532A is moved, which in turn moves entire surgicaldevice assembly 500 including shaft 567.

Thus, to reposition surgical device assembly 500 for entry guide 570MS,instrument manipulator positioning system 550 moves positioning element549 that in turn moves floating platform 532A so that insertion assembly531 and entire surgical device assembly 500 including shaft 567 aremoved from the position represented by the dotted lines to the positionshown in FIG. 5E by the solid lines. In one aspect, positioning element549 is moved by manually turning a knob. In another aspect, positioningelement 549 is moved using a servomotor.

Only one surgical device assembly 500 and its associated base assembly532 are shown in FIG. 5E. However, this is representative of each of thefour base assemblies in one aspect, and so the description is applicableto each of the total number of base assemblies, e.g., four baseassemblies, or in some aspects is applicable to a number of baseassemblies smaller than the total number of base assemblies. Also, theuse of an insertion assembly to couple the surgical device assembly tothe associated base assembly is illustrative only, and is not intendedto be limiting. In another aspect, the surgical device assembly iscoupled directly to the base assembly.

FIG. 5E also illustrates circular bending of shaft 567. In circularbending, the bend in shaft 567 is an arc of a circle. When shaft 567 iscircularly bent, the circular bend introduces the minimum stress overthe length of the bend of all of the possible bends, as discussed morecompletely below.

FIG. 6A is an illustration of one implementation of an instrumentmanipulator positioning system 640A in entry guide manipulator 530. Onlyone surgical device assembly 500 and its associated base assembly 532are shown in FIG. 6A. However, this is representative of each of thetotal number of base assemblies in one aspect, and so the description isapplicable to each of four base assemblies, or in some aspects isapplicable to a number of base assemblies smaller than the total numberof base assemblies.

Floating platform 600A, e.g., a moveable platform, in base assembly 532is connected to insertion assembly 531. Thus, as indicated above,movement of floating platform 600A moves the location of shaft 567. Apositioning element 610 in lateral motion mechanism of instrumentmanipulator positioning system 640A is coupled to floating platform600A. In this example, positioning element 610 and floating platform600A can be moved in four degrees of freedom, e.g., along a first axis601, along a second axis 602, in pitch 603, and in yaw 604. First axis601 and second axis 602 are in a plane that is perpendicular to alongitudinal axis of the entry guide, as previously shown.

In one aspect, platform 600A is suspended on a rail system so thatpositioning element 610 can move floating platform 600A and henceinsertion assembly 531 in directions 601, 602. Platform 600A also ismovably suspended on a support 620 that allows changing the pitch ofpositioning element 610 and platform 600A, e.g., the rail system ismounted on support 620. Support 620 can also rotate about anchor 630 tochange the yaw of positioning element 610 and platform 600A.

As indicated above, patient side support system 210E is used with a widevariety of entry guides. The particular entry guide used typicallydepends on the surgery being performed. In some instances, a channel inan entry guide may not extend straight through the entry guide. In thiscase, the instrument shafts exiting the entry guide are not all parallelto the longitudinal axis of the entry guide, but rather the instrumentshafts are splayed. The entry guide has one or more channels that are atan angle to the longitudinal axis of the entry guide, e.g., the channelis canted. For this entry guide, pitch and/or yaw of positioning element610 can be changed to insert shaft 567 into the chanted channel.

FIG. 6B is a cross-sectional view of an entry guide 670 with at leastone canted channel 670C, e.g., channel 670C is at an angle tolongitudinal axis 690. Longitudinal axis 690 extends from distal end670D of entry guide 670 to the proximal end 670P of entry guide 670.Lengthwise axis 670CL of channel 670C is angled relative to longitudinalaxis 690. Entry guide 670 may have more than the two channels visible inFIG. 6B.

In one aspect, channel 670C is a manual channel. The angle of the manualchannel is selected to facilitate aiming a manual instrument, e.g., astapler, at the center of the surgical site.

FIG. 6C illustrates an example of an instrument manipulator positioningsystem 640C that moves insertion assembly 531 and consequently shaft 567in two perpendicular directions 601, 602, i.e., in two degrees offreedom, in a plane perpendicular to a longitudinal axis of the entryguide. Insertion assembly 531 extends through an opening 653 in a secondfloating platform 600C. The proximal end of insertion assembly 531 ismounted to a first floating platform 600B. Platform 600B rides on afirst set of rails 663. Set of rails 663 is mounted on platform 600C. Aservomotor 660 is connected to platform 600B by a first positioningelement, in this aspect, by a lead screw 661 and a nut.

Platform 610C rides on a second set of rails 652. A servomotor 650 isconnected to platform 600B by a second positioning element, in thisaspect, by a lead screw 651 and a nut. Servomotor 650 moves platform600C and consequently insertion assembly 531 in direction 601.Servomotor 660 moves platform 600B and consequently insertion assembly531 in direction 602. To add the ability to change the pitch and yaw,set of rails 652 is mounted on support that has the two degrees offreedom. The configuration of positioning mechanism 640C is illustrativeonly and is not intended to be limiting to the specific elementsillustrated.

FIGS. 7A to 7C are a top, bottom, and oblique views respectively of oneaspect of a portion of a base assembly 732 that includes a floatingplatform 700. Base assembly 732 is representative of one aspect of baseassembly 432. In FIGS. 7A to 7C, only components necessary to understandthis aspect of floating platform 700 are included.

Floating platform 700 includes a first platform 700A and a secondplatform 700B. First platform 700A has legs 700L1, 700L2 (FIG. 7B). Leg700L1 has an outer side surface 700L1S that lies in a plane that isperpendicular to a plane including an inner side surface 700L2S of leg700L2. Axis 790 is along outer side surface 700L1S, while axis 791 isalong inner side surface 700L2S.

Outer side surface 700L1S of leg 700L1 is coupled to a first set ofprecision linear rails 752. Set of rails 752 is affixed to an inner sidesurface of base assembly 732. In FIGS. 7B and 7C, only the distal railin set 752 is visible. A proximal rail also is affixed to base assembly732. Sets of bearings 701 are mounted on outer side surface 700L1S ofleg 700L1. Sets of bearings 701 are preloaded and ride on set of rails752.

A side surface of second platform 700B is coupled to inner side surface700L2S of leg 700L2. A proximal portion 700B1 of second platform 700Bextends over a proximal end surface of leg 700L2. Another side surfaceof second platform 700B is affixed to a portion of insertion assembly731. In one aspect, insertion assembly 731 includes a frame, amid-carriage, and a distal carriage. The portion of insertion assembly731 illustrated in FIGS. 7A to 7C is the frame. The mid-carriage rideson a ball screw 713 in the frame. In one aspect, ball screw 713 has a 6mm pitch, and so ball screw 713 is back-drivable. The mid-carriageincludes metal belts that drive the distal carriage. The distal carriageis attached to the surgical device assembly.

A second set of precision linear rails 763 is affixed to inner sidesurface 700L2S of leg 700L2. Second set of rails 763 is perpendicular tofirst set of rails 752. In FIGS. 7B and 7C, only the distal rail in set763 is visible. A proximal rail also is affixed to inner side surface700L2S of leg 700L2. Sets of bearings 702 are mounted on a side surfaceof platform 700B. Sets of bearings 702 are preloaded and ride on set ofrails 763.

Proximal portion 700B 1 of second platform 700B includes a positioningelement receptacle 710 that is positioned in a circular opening 715 inproximal end surface of base assembly housing 732. As explained morecompletely below, a unit that includes the positioning element ismounted on housing 732 so that the positioning element, e.g., a pin,mates with positioning element receptacle 710. In one aspect, both thepin and positioning element receptacle 710 are made of strong steel andare precisely machined to minimize backlash in the coupling of the pinin positioning element receptacle 710. In one aspect, second platform700B is made of stainless steel, for example, Nitronic 60, thirtypercent cold worked. However, any strong steel that operates well, e.g.,does not exhibit galling or cold welding, with other steels can be used.

FIG. 7D is a cut-away illustration of one aspect of positioning elementreceptacle 710. A positioning element receptacle assembly 714 is mountedon proximal portion 700B 1 of second platform 700B. Positioning elementreceptacle assembly 714 includes a housing 714H, positioning elementreceptacle 710, and two bearings 711, 712. Positioning elementreceptacle 710 is a hollow cylinder, which is open at the proximal endand open at the distal end, in this aspect. Bearing 711 is positionedbetween housing 714H and positioning element receptacle 710 adjacent aproximal end of positioning element receptacle 710. Bearing 712 ispositioned between housing 714H and positioning element receptacle 710adjacent a distal end of positioning element receptacle 710. Bearings711 and 712 allow positioning element receptacle 710 to rotate relativeto housing 714H, and hence relative to second platform 700B. The use ofbearings 711 and 712 is illustrative only and is not intended to belimiting. In one aspect, bearings are not included in positioningelement receptacle assembly 714.

Platform 700 floats on sets of rails 752 and 763. When the positioningelement is mated with positioning receptacle 710, movement of thepositioning element moves floating platform 700 along one or both ofaxes 790, 791. Instrument manipulator positioning system 231E in entryguide manipulator 230E controls the location of insertion assembly 731by moving the positioning element to a particular location.

FIG. 8A is a first example of an instrument manipulator positioningsystem 840A that can be included in entry guide manipulator 230E andcoupled to floating platform 700. Instrument manipulator positioningsystem 840A includes an adjustment disk 841A that is coupled to a fixeddisk 870A. When adjustment disk 841A and fixed disk 870A movesynchronously together, rotation of fixed disk 870A rolls plurality ofsurgical device assemblies 300 as a group, as previously described.Specifically, adjustment disk 841A moves in synchronization with fixeddisk 870A so that rotation of fixed disk 870A rolls the surgical deviceassemblies coupled to adjustment disk 841A.

However, to position a shaft of an instrument for insertion into aparticular entry guide, adjustment disk 841A is first decoupled fromfixed disk 870A so that rotation of adjustment disk 841A is nottransferred to fixed disk 870A. For a given set of entry guides, alocation of the positioning element is known for the channel in eachentry guide. In this example, for the given set of entry guides, thepositioning element can moved to any one of five locations P0 to P5,which are known. The displacements needed to move the positioningelement from one location to the next are programmed in instrumentmanipulator positioning system 840A. In this example, an adjustment cam843A defines the location of positioning element for each of fivelocations P0 to P5.

A cam follower 842A is mounted to ride on adjustment cam 843A and in afixed slot 844A. Fixed slot 844A limits the range of motion of camfollower 842A, and so limits the motion of the positioning element. Inone aspect, two types of motions are possible using cam follower842A—linear motion along a line and circular motion along an arc.

For motion along a line, cam follow 842A includes a rod such that oneend of the rod rides in adjustment cam 843A and a second end of the rodextends, for example, into positioning element receptacle 710. Thus, asadjustment disk 841A rotates, the rod moves in fixed slot 844A, which inturn moves moving platform 700 and the distal end of an instrumentcoupled to insertion assembly 731 along a line in a plane.

For motion along an arc, a link rod 845 (FIG. 8B) connects cam follower842A to a rotary disk 846B. Positioning element 849B is affixed to aside surface of rotary disk 846B. As adjustment disk 841A is rotated, apin in the cam follower 842A follows adjustment cam 843A and acts like aslider crank to drive rotary disk 846B. Output pin 894B, the positioningelement, is mounted on a side surface of disk 846B. Thus, as rotary disk846B rotates, output pin 849B moves along a constant radius arc. In oneaspect, output pin 849B is mounted in positioning element receptacle710, and so the shaft of the instrument coupled to floating platform 700moves along a constant radius arc.

In one aspect (FIG. 8C), positioning element 849C is mounted on a sideof secondary disk 847. Secondary disk 847 is geared from rotary disk846C. Thus, output pin 849C follows an arc that is different from thearc followed by output pin 849B.

While in FIG. 8A only a single fixed slot, single cam follower andsingle adjustment cam are shown, adjustment disk 841A can include afixed slot, a cam follower, and an adjustment cam for each of pluralityof surgical device assemblies 300 or a fixed slot, a cam follower, andan adjustment cam for each of less than all of plurality of surgicaldevice assemblies 300.

FIG. 8D illustrates another example of an instrument manipulatorpositioning system 840D that can be included in entry guide manipulator230E and coupled to floating platform 700. Instrument manipulatorpositioning system 840D includes a fixed disk 870D. Plurality ofsurgical device assemblies 300 is coupled to fixed disk 870D in entryguide manipulator 230E so that rotation of fixed disk 870D rollsplurality of surgical device assemblies 300, as a group. Note that inthis aspect, an adjustment disk is not used, because the surgical deviceassemblies are moved manually to the correct location.

To position a shaft of an instrument for insertion into a particularentry guide, a user manually moves floating platform 700 untilpositioning element receptacle 710 aligns with one of five locations P0to P5, which are through holes in fixed disk 870D. In one aspect, theouter surface of the entry guide adjacent a channel includes a numberbetween 0 and 5 so that the operator knows which of the five locationsP0 to P5 to select.

When positioning element receptacle 710 is aligned with the correctlocation in fixed disk 870D, a pin is inserted through positioningelement receptacle 710 into the hole in fixed disk 870D to lock floatingplatform in place. In one aspect, a ball lock pin is used to lockfloating platform 700 to fixed disk 870D. While in FIG. 8D only a singleset of locations are illustrated, fixed disk 870D can include a set oflocations for each of plurality of surgical device assemblies 300 or foreach of less than all of plurality of surgical device assemblies 300.

FIG. 8E illustrates another example of an instrument manipulatorpositioning system 840E that can be included in entry guide manipulator230E and coupled to floating platform 700. Instrument manipulatorpositioning system 840E includes an adjustment path 843E in fixed disk870E. Plurality of surgical device assemblies 300 is coupled to fixeddisk 870E in entry guide manipulator 230E so that rotation of fixed disk870E rolls plurality of surgical device assemblies 300, as a group.

For a given set of entry guides, acceptable locations of positioningelement receptacle 710 are known for a channel in each entry guide. Inthis example, for the given set of entry guides, the acceptablelocations are along adjustment path 843E in fixed disk 870E.

However, to move a shaft of an instrument for insertion into aparticular entry guide, entry guide 270E is moved so that thelongitudinal axis of entry guide 270E is vertical. Next, a surgicalinstrument having a shaft is mounted onto an instrument manipulator toform a surgical device assembly, and the shaft of the surgical deviceassembly is inserted into a channel of entry guide 270E. If the shaft isbent, the instrument manipulator would move along adjustment path 843Eto a position of least energy, e.g., the instrument manipulator wouldmove to where the shaft is bent the least, and so the bend in the shaftis minimized. After the surgical device assembly has moved to theposition of least energy, floating platform 700 is locked to adjustmentpath 843E at that location. In one aspect, a ball lock pin is used tolock floating platform 700 to a location of adjustment path 843E offixed disk 870E. While in FIG. 8E only a single adjustment path 843E isillustrated, fixed disk 870E can include a set of adjustment paths, onepath each of plurality of surgical device assemblies 300 or one path foreach of less than all of plurality of surgical device assemblies 300.

FIG. 9 illustrates another aspect of an instrument manipulatorpositioning system 940 that is included in entry guide manipulator 230E.Instrument manipulator positioning system 940 includes a lateral motionmechanism. The lateral motion mechanism includes an adjustment gear 941,sometimes referred to as a drive gear or an adjustment ring gear, and aplurality of gearboxes 942_0, 942_1, 942_2, 942_3. As described morecompletely below, each of gearboxes 942_0, 942_1, 942_2, 942_3 has aninput spur gear, which engages adjustment gear 941, and an output pin.The output pin is the positioning element described above. Eachpositioning element mates with a positioning element receptacle in afloating platform, e.g., positioning element receptacle 710 in floatingplatform 700.

Each of gearboxes 942_0, 942_1, 942_2, 942_3 is installed with a releasepin 943_0, 943_1, 943_2, 943_3. The release pin locks each gearboxduring installation, which ensures that the gearboxes are properlysynchronized. In FIG. 9, release pin 943_1 has been removed from gearbox942_1.

In one aspect, turning adjustment gear 941 causes each of gearboxes942_0, 942_1, 942_2, 942_3 to move the positioning element so that thefloating platform coupled to the positioning element moves on a specifictrajectory. As described previously, an insertion assembly is attachedto the floating platform and a surgical device assembly is attached tothe insertion assembly. Thus, as the positioning element moves thefloating platform on the specific trajectory, the distal end of thesurgical instrument shaft follows that specific trajectory.

In FIG. 9, gearboxes 942_0, 942_1, 942_2, 942_3 are representative of aset of gearboxes. In FIGS. 10A to 10D, a first set of gearboxes isillustrated. In FIGS. 11A to 11K, a second set of gearboxes isillustrated. The combination of gearboxes in a set is illustrative onlyand is not intended to be limiting. As explained more completely below,the particular combination of gearboxes used in a set of gearboxes forFIG. 9 is determined by the entry guides and instruments used withpatient side support system 210E.

Also, the use of four gearbox sets is illustrative only and is notintended to be limiting. In view of this disclosure, a set of gearboxescan include any number of gearboxes, e.g., one for each manipulatorassembly 240 that is to be automatically positioned. With a set of fourgearboxes, each of the four manipulator assemblies in FIGS. 3A and 3B isautomatically positioned. However, as explained above, some aspects mayinclude more than four manipulator assemblies (see FIG. 5F) in a system,and so if all the manipulator assemblies are automatically positioned,the set of gearboxes can include more than four gearboxes in such asystem. Similarly, if less than all of the manipulator assemblies wereautomatically positioned, the number of gearboxes in a set would be lessthan the total number of manipulator assemblies. FIG. 9 is not repeatedfor each of the possible combinations of gearboxes in a set, because inview of this disclosure, one knowledgeable in the field can selectgearboxes for the number of manipulator assemblies that areautomatically positioned to accommodate different instruments and/orguide tubes, e.g., the number of gearboxes in a set can vary from one upto the total number of manipulator assemblies in the system.

In one aspect, two types of gearboxes are used in a first set ofgearboxes. A first gearbox moves the positioning element on a circulartrajectory. A second gearbox moves the positioning element on a lineartrajectory. In this aspect, a linear trajectory gearbox 942_0_1 (FIGS.10C and 10D) is used for gearbox 942_0 (FIG. 9), while a circulartrajectory gearbox 942 (FIGS. 10A and 10B) is used for each of gearboxes942_1, 942_2, 942_3 (FIG. 9). This combination of gearboxes isillustrative only and is not intended to be limiting. As explained morecompletely below, the particular combination of gearboxes used in FIG. 9is determined by the entry guides and instruments used with patient sidesupport system 210E.

FIG. 10A is a proximal view of a gearbox 942. In this aspect, gearbox942 represents each of gearboxes 942_1, 942_2, and 942_3 in FIG. 9,which have a circular trajectory. FIG. 10B is a distal view of gearbox942. In FIGS. 10A and 10B, parts of the gearbox housing have beenremoved.

Gearbox 942 has a housing that supports a gear train including an inputgear 1001_A and an output gear 1002_A. Above, input gear 1001_A wasreferred to as an input spur gear.

An output pin 1049_B, e.g., a positioning element, is mounted on adistal side surface 1002S_B of output gear 1002_A. In this aspect,output pin 1049_B is mounted on output gear 1002_A offset from thecenter of rotation of output gear 1002_A. Thus, the trajectory of outputpin 1049_B and consequently, the shaft of the surgical instrument, is aconstant radius arc. In one aspect, output pin 1049_B is a stainlesssteel pin, for example, Nitronic 60, thirty percent cold worked.However, any strong steel that operates well, i.e., does not exhibitgalling or cold welding, with other steels can be used.

Output pin 1049_B extends distally from surface 1002S_B through anopening 1044_B in a distal side 1032S_B of the housing. A shape ofopening 1044_B is selected to control the range of motion of output pin1049_B. Thus, opening 1044_B is a motion stop for output pin 1049_B.

FIG. 10C is a proximal view of gearbox 942_0_1, which is a lineartrajectory gearbox. Gearbox 942_0_1 is an example of gearbox 942_0 (FIG.9). FIG. 10D is a distal view of gearbox 942_0_1. In FIGS. 10C and 10D,the gearbox housing is transparent so that the elements inside thehousing can be seen.

Gearbox 942_0_1 has a housing that supports a gear train including aninput gear 1001_C and a cam gear 1002_C. Cam gear 1002_C includes anadjustment cam 1043 that is a slot machined into cam gear 1002_C fromdistal surface 1002S_D (FIG. 10D). Thus, adjustment cam 1043 issometimes referred to as cam slot 1043.

A proximal end of an output pin 1049_D, e.g., a proximal end of apositioning element, rides in adjustment cam 1043. Output pin 1049_D ismounted in a carriage 1005 that rides on a pair on linear rails 1052.Linear rails 1052 are mounted on an inner distal surface of the housing.In one aspect, output pin 1049_D is a stainless steel pin, for example,Nitronic 60, thirty percent cold worked. However, any strong steel thatoperates well, i.e., does not exhibit galling or cold welding, withother steels can be used.

Output pin 1049_D extends distally through a fixed slot 1044_D in adistal side 1032S_D of the housing. The size of fixed slot 1044_D isselected to control the range of motion of output pin 1049_D. Thus,fixed slot 1044_D is a motion stop for output pin 1049_D.

As input gear 1001_C drives cam gear 1002_C, adjustment cam 1043 movesoutput pin 1049_D. Normally, there would be a fair amount of frictionbetween output pin 1049_D and cam slot 1043 as cam gear 1002_C rotates.However, in one aspect, a pair of bearings is mounted on output pin1049_D where output pin 1049_D sits in cam slot 1043 so that gearbox942_0_1 transmits the pin motion through bearing rolling action ratherthan sliding motion.

In gearbox 942_0_1, the position of output pin 1049_D is guided by theprofile of adjustment cam 1043_D. However, carriage 1005 and linearrails 1052 restrict the movement of output pin 1049_D to motion on astraight line. This configuration has the benefit of being reversible,which makes the ordering of the output pin positions more flexible.

In another aspect, a second set of gearboxes includes four differentgearboxes as illustrated in FIGS. 11A to 11K. FIG. 11A is a proximalview of gearbox 942_0_2, which is a linear trajectory gearbox. Gearbox942_0_2 is an example of 942_0 (FIG. 9). Gearbox 942_0_2 is a firstgearbox in the second set of gearboxes, and typically is used toposition a camera instrument. FIG. 11B is a distal view of gearbox942_0_2. In FIGS. 11A and 11B, the gearbox housing is transparent sothat the elements inside the housing can be seen. In FIG. 11A, releasepin 943_0_2 has been removed from gearbox 942_0_2, and so is not shown.

Gearbox 942_0_2 has a housing that supports a gear train including aninput gear 1101_A and a cam gear 1102_A. Cam gear 1102_A includes anadjustment cam 1143_B that is a slot machined into cam gear 1102_A fromdistal surface 1102DS_B (FIG. 11B). Thus, adjustment cam 1143_B issometimes referred to as cam slot 1143_B.

A proximal end of an output pin 1149_B is coupled to a cam follower,e.g., a proximal end of a positioning element is coupled to a camfollower, which rides in adjustment cam 1143_B. Output pin 1149_Bextends distally through a fixed slot 1144_B in a distal side 1132DS_Bof the housing. The size of fixed slot 1144_B is selected based on therange of motion of output pin 1149_B. The width of fixed slot 1144_B iswide enough to accommodate the part of output pin output pin 1149_B thatrolls on an edge surface of the slot plus a tolerance.

In this aspect, a stop pin 1103_A extends in a proximal direction fromproximal surface 1102PS_A of cam gear 1102_A. Stop pin 1103_A rides in aslot 1104_A in an interior surface of a proximal side 1132PS_A of thehousing. Stop pin 1103_A in combination with slot 1104_A limits therange of rotation of cam gear 1102_A, and so the combination is a rangeof motion stop.

As input gear 1101_A rotates cam gear 1102_A, adjustment cam 1143_Bmoves output pin 1149_B in slot 1144_B. The position of output pin1149_B is guided by the profile of adjustment cam 1143_D. However, slot1144_B restrains the movement of output pin 1149_B to motion on astraight line. See FIG. 18C.

FIG. 11C is a proximal view of gearbox 942_1_2, which is a first twodegree-of-freedom trajectory gearbox. Gearbox 942_1_2 is an example of942_1 (FIG. 9). Gearbox 942_1_2 is a second gearbox in the second set ofgearboxes. FIG. 11D is a distal view of gearbox 942_0_2. In FIGS. 11Cand 11D, the gearbox housing is transparent so that the elements insidethe housing can be seen. In FIG. 11C, release pin 943_1_2 has beenremoved from gearbox 942_1_2, and so is not shown.

Gearbox 942_1_2 has a housing that supports a gear train including aninput gear 1101_C and a cam gear 1102_C. Cam gear 1102_C includes anadjustment cam 1143_D that is a slot machined into cam gear 1102_C fromdistal surface 1102DS_D (FIG. 11B). Thus, adjustment cam 1143_D issometimes referred to as cam slot 1143_D.

A proximal end of an output pin 1149_D is coupled to a cam follower,e.g., a proximal end of a positioning element is coupled to a camfollower, which rides in adjustment cam 1143_D. Output pin 1149_Dextends distally through a fixed slot 1144_D in a distal side 1132DS_Dof the housing. The size of fixed slot 1144_D is selected based on therange of motion of output pin 1149_D. The width of fixed slot 1144_D iswide enough to accommodate the part of output pin output pin 1149_D thatrolls on an edge surface of the slot plus a tolerance.

In this aspect, a stop pin 1103_C extends in a proximal direction fromproximal surface 1102PS_C of cam gear 1102_C. Stop pin 1103_C rides in aslot 1104_C in an interior surface of a proximal side 1132PS_C of thehousing. Stop pin 1103_C in combination with slot 1104_C limits therange of rotation of cam gear 1102_C, and so the combination is a rangeof motion stop.

As input gear 1101_C rotates cam gear 1102_C, adjustment cam 1143_Dmoves output pin 1149_D in slot 1144_D. The position of output pin1149_D is guided by the profile of adjustment cam 1143_D. However, slot1144_D restrains the movement of output pin 1149_D to motion on acombination of two arcs. Output pin 1149_D has two degrees of freedom.See FIG. 18E.

FIGS. 11E and 11F are proximal views of gearbox 942_2_2, which is asecond two degree-of-freedom trajectory gearbox. Gearbox 942_2_2 is anexample of 942_2 (FIG. 9). Gearbox 942_2_2 is a third gearbox in thesecond set of gearboxes. FIG. 11G is a distal view of gearbox 942_2_2.FIG. 11H is a cross-sectional view of gearbox 942_2_2. In FIGS. 11E,11F, and 11G, the gearbox housing is transparent so that the elementsinside the housing can be seen.

Gearbox 942_2_2 has a housing that supports a gear train including aninput gear 1101_E and a cam gear 1102_E. Cam gear 1102_E includes anadjustment cam 1143_G that is a slot machined into cam gear 1102_E fromdistal surface 1102DS_G (FIG. 11B). Thus, adjustment cam 1143_G issometimes referred to as cam slot 1143_G.

In FIG. 11E, release pin 943_2_2 is shown inserted in gearbox 942_2_2.As described previously, each release pin, e.g., release pin 943_2_2,locks its gearbox during installation, which ensures that the gearbox isproperly synchronized with adjustment gear 941. In FIG. 11F, release pin943_2_2 has been removed from gearbox 942_2_2.

A proximal end of an output pin 1149_G is coupled to a cam follower,e.g., a proximal end of a positioning element is coupled to a camfollower, which rides in adjustment cam 1143_G. Output pin 1149_Gextends distally through a fixed slot 1144_G in a distal side 1132DS_Gof the housing. The size of fixed slot 1144_G is selected based on therange of motion of output pin 1149_G. The width of fixed slot 1144_G iswide enough to accommodate the part of output pin 1149_G that rolls onan edge surface of the slot plus a tolerance.

In this aspect, a stop pin 1103_E extends in a proximal direction fromproximal surface 1102PS_E of cam gear 1102_E. Stop pin 1103_E rides in aslot 1104_E in an interior surface of a proximal side 1132PS_E of thehousing. Stop pin 1103_E in combination with slot 1104_E limits therange of rotation of cam gear 1102_A, and so the combination is a rangeof motion stop.

As input gear 1101_E rotates cam gear 1102_E, adjustment cam 1143_Gmoves output pin 1149_G in slot 1144_G. The position of output pin1149_G is guided by the profile of adjustment cam 1143_G. However, slot1144_G restrains the movement of output pin 1149_G to motion on acombination of a line and an arc. Output pin 1149_G has two degrees offreedom. See FIG. 18G.

Each of the other gearboxes in the second set, i.e., gearboxes 942_0_2,942_1_2, and 942_3_2 has a cross-sectional view similar to the crosssectional view for gearbox 942_2_2 in FIG. 11H. Thus, a cross-sectionalview of each gearboxes 942_0_2, 942_1_2, and 942_3_2 would not add anyadditional information, and so is not presented. As shown in FIG. 11H,in this aspect, output pin 1149_G is coupled to a cam follower 1160 by abushing 1161. Cam follower 1160 rides in cam slot 1104_E. In thisaspect, no bearings are used to support output pin 1149_G, becauseoutput pin 1149_G is supported by bearings 711 and 712 in positioningelement receptacle assembly 714 (FIG. 7D). In this aspect, the housingof gearbox 942_2_2 includes a base 1170_G and a lid 1171_G.

FIG. 11I is a proximal view of gearbox 942_3_2, which is a third twodegree-of-freedom trajectory gearbox. Gearbox 942_3_2 is an example of942_3 (FIG. 9). Gearbox 942_3_2 is a fourth gearbox in the second set ofgearboxes. FIG. 11J is a distal view of gearbox 942_3_2. In FIGS. 11Iand 11J, the gearbox housing is transparent so that the elements insidethe housing can be seen. In FIG. 11I, release pin 943_3_2 has beenremoved from gearbox 942_3_2, and so is not shown.

Gearbox 942_3_2 has a housing that supports a gear train including areversing idler gear, 1108_I, an input gear 1101_I and a cam gear1102_I. Reversing idler gear 1108_I rides on adjustment gear 941, anddrives cam gear 1102_I. Reversing idler gear 1108_I is used, in thisaspect, to assure that the manipulator positioning system does not enteran unstable state. Cam gear 1102_I includes an adjustment cam 1143_Jthat is a slot machined into cam gear 1102_I from distal surface1102DS_J (FIG. 11J). Thus, adjustment cam 1143_J is sometimes referredto as cam slot 1143_J.

A proximal end of an output pin 1149_J is coupled to a cam follower,e.g., a proximal end of a positioning element is coupled to a camfollower, which rides in adjustment cam 1143_J. Output pin 1149_Jextends distally through a fixed slot 1144_J in a distal side 1132DS_Jof the housing. The size of fixed slot 1144_J is selected based on therange of motion of output pin 1149_J. The width of fixed slot 1144_J iswide enough to accommodate the part of output pin output pin 1149_J thatrolls on an edge surface of the slot plus a tolerance.

In this aspect, a stop pin 1103_I extends in a proximal direction fromproximal surface 1102PS_I of cam gear 1102_I. Stop pin 1103_I rides in aslot 1104_I in an interior surface of a proximal side 1132PS_I of thehousing. Stop pin 1103_I in combination with slot 1104_I limits therange of rotation of cam gear 1102_I, and so the combination is a rangeof motion stop.

As input gear 1101_I rotates cam gear 1102_I, adjustment cam 1143_Jmoves output pin 1149_J in slot 1144_J. The position of output pin1149_J is guided by the profile of adjustment cam 1143_J. However, slot1144_J restrains the movement of output pin 1149_J to motion on acombination of two arcs. Output pin 1149_J has two degrees of freedom.See FIG. 18I.

FIG. 11K is a more detailed diagram of cam gear 1102_I. In one aspect,output pin 1149_J is moved to one of seven positions by rotation of camgear 1102_I. The seven positions of output pin 1149_J are represented bydotted lines 1149_J_1 to 1149_J_7 in cam slot 1143_J. The lightercolored lines in FIG. 11K are working lines and are not essential.

At each location where output pin 1149_J stops in cam slot 1143_J, thecam surface is flat, i.e., the flat surface of the cam is perpendicularto a radial line through the center of cam gear 1102_I. This preventsback driving of cam gear 1102_I. In some situations, surgical deviceassemblies 300 may be positioned such that the weight of a surgicaldevice assembly transfers a force to the corresponding output pin forthat assembly. The flat spots at the stop locations of output pin 1149_Jassures that the only force transferred by the pin to cam gear 1102_I isa radial force through the center of cam gear 1102_I, and so backdriving of cam gear 1102_I is not a problem. Cam gear 1102_I is alsorepresentative of the cam gears in each of the other gearboxes in thesecond set although the cam surfaces are not the same in each gearbox.

Another feature of cam gear 1102_I is that output pin 1149_J is moved tothe appropriate stop position, as shown in FIG. 11K, by even incrementsof rotation of cam gear 1102. In this example, cam gear 1102_I isrotated ninety degrees to move output pin 1149_J from location1149_J_1—the draping position—to location 1149_J_2 and then cam gear1102_I is rotated forty-five degrees to move output pin 1149_J to eachsubsequent stop location, i.e., locations 1149_J_3 to 1149_J_7. Stoplocations 1149_J_2 to 1149_J_7 are not at even increments in FIG. 11Kbecause while cam gear 1102_I rotates in even increments, output pin1149_J is constrained to move in cam slot 1143_J.

In one aspect, each of the gearboxes in the second set of gearboxes isconstructed using the same materials. The base is made from 2024-T4aluminum. The lid is made from 6061-T6 aluminum. All of the gearsincluding the cam gear are made from 2024-T4 aluminum. In one aspect,each of the output pins is a stainless steel pin, for example, Nitronic60, thirty percent cold worked, or 416 stainless steel. However, anystrong steel that operates well, i.e., does not exhibit galling or coldwelding, with other steels can be used. The materials mentioned here areillustrative only and are not intended to be limiting. Other equivalentmetals and/or plastics could also be used.

In one aspect, a roll system and an instrument manipulator positioningsystem are both contained in entry guide manipulator 230E. The rollsystem includes a roll ring gear that is used to roll plurality ofsurgical device assemblies 300 (FIG. 3B). Adjustment ring gear 941 ofinstrument manipulator positioning system 940 interfaces with an inputgear in each gearbox, e.g., gearboxes 942_0 to 942_3.

The output pin in each of the gearboxes is moved, for example, in one oftwo ways. The roll ring gear is held stationary, and the adjustment ringgear is rotated, or the adjustment ring gear is held stationary and theroll ring gear rotated. In general however, proper positioning can beobtained if one of the two gears is moved differentially with respect tothe other gear, e.g., the two gears are moved with different angularvelocity.

FIGS. 12A to 12D illustrate an example of an entry guide manipulator inwhich the roll ring gear is held stationary and the adjustment ring gearis rotated to move simultaneously each of the surgical device assembliesso that its instrument shaft is in the appropriate position for passingthrough a channel in an entry guide with damaging the surgicalinstrument. FIGS. 13A and 13D illustrate an example of an entry guidemanipulator in which the adjustment ring gear is held stationary and theroll ring gear is rotated to move simultaneously each of the surgicaldevice assemblies so that its instrument shaft is in the appropriateposition for passing through a channel in an entry guide withoutdamaging the surgical instrument. In both examples, during normaloperations, the rotation of the roll ring gear and adjustment ring gearis synchronous, which means that that the two ring gears rotate togetherat the same angular velocity.

These examples are illustrative only and are not intended to belimiting. In view of this disclosure, other methods that move the rollring gear and the adjustment ring gear asynchronously, e.g., move thetwo gears differentially, can be used to move the surgical deviceassemblies to the appropriate positions to enable passing their shaftsthrough an entry guide, e.g., the two ring gears could be rotated atdifferent angular velocities.

FIG. 12A is a schematic diagram of another aspect of an entry guidemanipulator 230D with a roll system 1210 and an instrument manipulatorpositioning system 1220. Roll system 1210 rolls all of the surgicalinstruments assemblies coupled to entry guide manipulator 230D as agroup. Instrument manipulator positioning system 1220 simultaneouslymoves all or some of the surgical instruments assemblies coupled toentry guide manipulator 230D, as needed, to align the shafts of thesurgical device assemblies with different channels in an entry guide sothat the shafts can enter and pass through the entry guide withoutexceeding the stress limits on the shafts if the shafts are bent uponentry to the entry guide.

A drive assembly 1290 is coupled to roll system 1210 and to instrumentmanipulator positioning system 1220. A surgical device assembly 1230 iscoupled to manipulator position system 1220. While it not shown in FIG.12A, surgical device assembly 1230 is also coupled to roll system 1210.

Roll system 1210 includes a roll ring gear 1270. Roll system 1210includes other components, but these components are not shown in thedrawings to facilitate the description of drive assembly 1290.Instrument manipulator positioning system 1220 includes an adjustmentring gear 1241 and a gearbox 942D. Gearbox 942D includes a positioningelement. Surgical device assembly 1230 is coupled to the positioningelement in gearbox 942D, for example as described above, so that whenthe positioning element moves the shaft of the instrument also is moved.When gearbox 942D moves the positioning element, the position the shaftof surgical device assembly 1230 moves in a plane, which in one aspectis a lateral plane that is perpendicular to a longitudinal axis of theentry guide.

In FIG. 12A, only a single gearbox 942D is shown for ease of discussion.However, adjustment ring gear 1241 engages a plurality of gearboxes inmanner equivalent to that illustrated in FIG. 9 and each gearbox iscouplable to a surgical device assembly. Surgical device assembly 1230is equivalent to a surgical device in the plurality of surgical deviceassemblies 300 described above, and so that description is not repeatedhere.

Drive assembly 1290 includes a roll motor assembly 1291 that is coupledto roll ring gear 1270 and to adjustment ring gear 1241. Adjustment ringgear 1241 is sometimes referred to as an adjustment gear. In a rolloperation, roll motor assembly 1291 drives roll ring gear 1270 andadjustment ring gear 1241 so that the rotation of the two gears issynchronized.

A brake 1292 and a clutch 1295 are coupled to roll ring gear 1270. Anadjustment gear drive assembly 1293 is coupled to adjustment ring gear1241. In this aspect, when clutch 1295 is disengaged by moving a knob1294 with a linear motion, adjustment gear drive assembly 1293 can thenbe manually operated by turning knob 1294.

In a manipulator position adjustment process, knob 1294 disengagesclutch 1295, and brake 1292 prevents roll ring gear 1270 from turning.Turning knob 1294 causes adjustment gear drive assembly 1293 to rotateadjustment ring gear 1241. Because roll ring gear 1270 is heldstationary, gearbox 942D does not move. However, the rotation ofadjustment gear drive assembly 1293 moves the positioning element ingearbox 942D, as described above, which in turn changes the position ofthe shaft of surgical device assembly 1230. The differential motionbetween roll ring gear 1270 and adjustment ring gear 1241 controls themovement of the positioning element in gearbox 942D.

FIG. 12B illustrates one configuration with roll ring gear 1270 andadjustment ring gear 1241 mounted in a housing 1232 of entry guidemanipulator 230D. In one aspect, adjustment ring gear 1241 can be eitheradjustment disk 841 or adjustment gear 941.

Roll ring gear 1270 rotates inside housing 1232 on a four-point contactbearing, in one aspect. Adjustment ring gear 1241 is free to rotate onroll ring gear 1270, and is driven by output gear 1202 (FIG. 12C) in aplanetary gear differential mechanism 1250. FIG. 12C is a crosssectional view of one aspect of planetary gear differential mechanism1250, while FIG. 12D is a bottom view of planetary gear differentialmechanism 1250. Planetary gear differential mechanism 1250 is an exampleof an implementation of clutch 1295 and adjustment gear drive assembly1293.

Motion of adjustment ring gear 1241 relative to roll ring gear 1270 iscontrolled by a user through a single manual knob 1294 located onhousing 1232. Knob 1294 is mounted on a spline shaft 1218.

To drive adjustment ring gear 1241, the user pulls knob 1294 againstknob preload spring 1219 to disengage knob 1294 from lock 1213 and thenrotates knob 1294. When used this way, roll ring gear 1270 is disengagedfrom knob 1294 by clutch 1295 and brake 1292 prevents motion of rollring gear 1270 (which effectively locks sun gear 1217), and the rotationof knob 1294 rotates planet carrier 1215. The rotation of planet carrier1215 rotates planet gears 1216 that in turn drives ring gear 1214. Ringgear 1214 drives output gear 1202. The teeth on output gear 1202 meshwith teeth on the perimeter of adjustment ring gear 1241. Thus, theengagement of knob 1294 locks roll ring gear 1270, and the rotation ofknob 1294 rotates adjustment ring gear 1241. The rotation of adjustmentring gear 1241 moves the positioning elements as described above. Gears1201 and 1220 are idler gears configured to assist in proper operationof the structure.

The gear ratios of all components in planetary gear differentialmechanism 1250 are selected to ensure that adjustment ring gear 1241 androll ring gear 1270 are synchronized when the knob 1294 is locked andclutch 1295 is engaged. The gear ratios are also selected to get anadequate relationship between the knob rotation and adjustment diskrotation. In one aspect, positions on knob 1294 corresponding topositions of the positioning elements are communicated to the user as aball-detent click, and the positions may have some over-center feel aswell.

In this aspect, manual control of adjustment ring gear 1241 is used. Inanother aspect, knob 1294 is eliminated and spline shaft 1218 is coupledto a shaft of a servomotor or to a solenoid. The servomotor isconfigured to push or pull against preload spring 1219 to lock roll ringgear 1270 and engage adjustment ring gear 1241, as described above formanual operation.

FIG. 13A is a schematic diagram of another aspect of an entry guidemanipulator 230E with a roll system 1310 and an instrument manipulatorpositioning system 1320. Roll system 1310 rolls all of the instrumentsassemblies coupled to system 1310 as a group. Instrument manipulatorpositioning system 1320 simultaneously positions all or some of theinstruments assemblies coupled to system 1310 to enable insertion ofshafts of the surgical device assemblies into different channels in anentry guide without damaging the instruments.

A drive assembly 1390 is coupled to roll system 1310 and to instrumentmanipulator positioning system 1320. A surgical device assembly 1330 iscoupled to manipulator position system 1320. While it not shown in FIG.13A, surgical device assembly 1330 is also coupled to roll system 1310.

Roll system 1310 includes a roll ring gear 1370. Instrument manipulatorpositioning system 1320 includes an adjustment ring gear 1341 and agearbox 942D. Gearbox 942D includes a positioning element. Surgicaldevice assembly 1330 is coupled to the positioning element in gearbox942D, for example as described above. When gearbox 942D moves thepositioning element, the position of the shaft of surgical deviceassembly 1330 moves in a plane, which in one aspect is a lateral plane.The lateral plane is perpendicular to the axis of rotation of entryguide manipulator 230E.

In FIG. 13A, only a single gearbox 942D is shown for ease of discussion.However, adjustment ring gear 1341 engages a plurality of gearboxes inmanner equivalent to that illustrated in FIG. 9 and each gearbox iscouplable to a surgical device assembly. Surgical device assembly 1330is equivalent to surgical device assembly 300 described above, and sothat description is not repeated here.

In this aspect, drive assembly 1390 includes a roll motor assembly 1391,a clutch 1392, and a brake 1393. Roll motor assembly 1391 is directlycoupled to roll ring gear 1370 and is directly coupled to adjustmentring gear 1341 through clutch 1392, when clutch 1392 is engaged. Whenclutch 1392 is dis-engaged, roll motor assembly 1391 is not coupled toadjustment ring gear 1341.

Brake 1393 is directly coupled to adjustment ring gear 1341. When brake1393 is engaged, brake 1393 prevents adjustment ring gear 1341 fromturning. When brake 1393 is disengaged, adjustment ring gear 1341 canrotate.

In one aspect, clutch 1392 and brake 1393 are implemented aselectromagnetic components. Clutch 1392 is implemented so that whenpower is applied to clutch 1392, clutch 1392 is released, i.e.,dis-engaged, and when there is no power applied, clutch 1392 is engaged.Brake 1393 is implemented so that when power is applied, brake 1393 isreleased, and where there is no power brake is engaged.

Entry guide manipulator 230E, in one aspect, has at least three modes ofoperation: a roll mode, a fault mode, and an instrument manipulatorpositioning system adjustment mode. In the roll mode, the surgicaldevice assemblies coupled to roll system 1310 are rolled as a group. Inthe fault mode, both roll system 1310 and instrument manipulatorpositioning system 1320 are disabled. In the instrument manipulatorpositioning system adjustment mode, each surgical device assemblycoupled to system 1320 is individually moved so that its instrumentshaft is in the appropriate position for passing through an entry guidewithout exceeding the stress limits for that shaft. Table 1 is anexample of how the control system powers clutch 1392 and brake 1393 ineach mode of operation.

TABLE 1 Mode Brake 1393 Clutch 1392 Roll Energized = releasedNot-energized = engaged Fault Not-energized = engaged Not-energized =engaged Adjustment Not-energized = engaged Energized = released

Returning to FIG. 13A, in the roll mode, brake 1393 is released andclutch 1392 is engaged. Thus, roll motor assembly 1391 drives roll ringgear 1370 and adjustment ring gear 1341 so that the rotation of the tworing gears is synchronous.

In the fault mode, power is cut to both clutch 1392 and brake 1393.Thus, both brake 1393 and clutch 1392 are engaged. Brake 1393 preventsadjustment ring gear 1341 from rotating. Since roll ring gear 1370 isconnected to adjustment ring gear 1341 through engaged clutch 1392, rollring gear 1370 is also prevented from rotating by brake 1393. Thus, inthe fault mode, any motion of either ring gear is inhibited.

In the adjustment mode, clutch 1392 is released, and brake 1393 isengaged. Thus, adjustment ring gear 1341 is preventing from rotating,while roll motor assembly 1391 rotates roll ring gear 1370. Roll ringgear 1370 is rotated until the difference in position between adjustmentring gear 1341 and roll ring gear 1370 is such that the instrumentshafts are properly positioned.

In the prior example of FIGS. 12A to 12D, the gearboxes were heldstationary, and motion of adjustment ring gear 1241 turned the inputgears of the gearboxes to position the output pins. Here, the gearboxesare rotated relative to adjustment ring gear 1341 and this motion turnsthe gears in the gearbox so that that the output pins, the positioningelements, are moved to the correct location.

FIGS. 13B to 13D are more detailed illustrations of one aspect ofimplementing entry guide manipulator 230E of FIG. 13A. FIG. 13B is anillustration of entry guide manipulator 230E with the cover removed.Gearboxes 942_1, 942_2 (see FIG. 9), base assemblies 732_1, 732_3 (seeFIGS. 7A to 7C), and insertion assemblies 731_1, 731-3 (see FIGS. 7A to7C) are visible in FIG. 13B. The outer gear teeth of adjustment ringgear 1341 and the gear teeth of roll ring gear 1370 are also visible inFIG. 13B. The outer diameter of adjustment ring gear 1341 is the same asthe outer diameter as roll ring 1370. Digital potentiometer 1350measures the absolute position of roll ring gear 2370 with respect to amechanical ground of entry guide manipulator 230E.

FIG. 13C is a cut away illustration that shows the interface betweenadjustment ring gear 1341 and input gear 1001 of gearbox 942_1. The gearteeth of input gear 1001 engage the inner gear teeth of adjustment ringgear 1341.

FIG. 13D is a cut away illustration of a drive assembly 1390 for rollgear assembly 1310 and instrument manipulator positioning system 1320.Motor assembly 1391, clutch 1392, brake 1393, and a second potentiometer1351 are mounted in a housing 1394 of drive assembly 1390. As usedherein, a clutch connects and disconnects one shaft to and from anothershaft, and a brake connects and disconnects a shaft to and from ground.

Motor output gear 1317 drives roll gear train 1371, and roll gear train1371 drives roll ring gear 1370. Roll gear train 1371 includes a rollinput gear 1372 and a roll output gear 1373. Roll input gear 1372 and aroll output gear 1373 spin together.

Adjustment gear train 1360 is coupled to roll gear train 1371 by clutch1392. Sometimes adjustment gear train 1360 is referred to as instrumentmanipulator positioning system gear train 1360. Adjustment gear train1360 drives adjustment ring gear 1341. Adjustment gear train 1360includes an adjustment input gear 1361 and an adjustment output gear1362. Adjustment input gear 1361 and adjustment output gear 1362 spintogether.

The ratios of the gears in roll gear train 1371 and in adjustment geartrain 1360 are the same. Thus, when both gear trains 1371 and 1360 aredriven by motor 1391, roll ring gear 1370 and adjustment ring gear 1341rotate synchronously, e.g., roll ring gear 1370 and adjustment ring gear1341 spin one to one.

In this example, roll motor assembly 1391 is a compact high torqueslotless brushless direct current motor 1312 with a shaft 1313. Rollmotor assembly 1391 includes a hall sensor assembly 1314 and an encoder1315. Motor shaft 1313 is coupled to a harmonic gear drive 1316.Harmonic gear drive 1316 is coupled to a motor output gear 1317.

As is known to those knowledgeable in the field, harmonic gear drive1316 includes three components: a wave generator, a flexspline, and acircular spline. Harmonic gear drive 1316 has zero backlash, highpositional accuracy relative to other gearing technologies, and a hightorque-to-weight ratio relative to other gearing technologies.

Motor output gear 1317 drives roll input gear 1372 in a roll system geartrain 1371. Roll input gear 1372 is mounted on a pair of bearings. Thepair of bearings is mounted on shaft 1331 of clutch 1392. A hub 1335 ofclutch 1392 is affixed to roll input gear 1372 in roll system gear train1371.

Shaft 1331 of clutch 1392 is rotatably mounted in housing 1394 using abearing on each end of shaft 1331. Adjustment input gear 1361 ofinstrument manipulator positioning system gear train 1360 is fixedlymounted on shaft 1331 so that as shaft 1331 spins, adjustment input gear1361 rotates.

Hub 1335 of clutch 1392 is mounted on shaft 1331 through a hub on rollinput gear 1372. Armature 1334 contains permanent magnets and isconnected mechanically to hub 1335 by leaf springs so that armature1334, hub 1335, and roll input gear 1372 rotate as a unit about shaft1331.

Rotor 1333 is mounted on shaft 1331 so that when rotor 1331 spins, shaft1331 spins also. When there is no power applied to electromagnetic coil1332, permanent magnet armature 1334 also attaches to rotor 1333 and soadjustment input gear 1361 rotates synchronously with roll input gear1372 when brake 1393 is not engaged.

When power is applied to electromagnetic coil 1332, the current flowthrough electromagnetic coil 1332 creates a magnetic field thatmagnetizes rotor 1333 so that there is no longer any magnetic attachmentbetween rotor 1333 and armature 1334. The leaf springs connectingarmature 1334 and hub 1335 pull the armature 1334 upward and separatethe armature 1334 from the rotor 1333. Thus, armature 1334 and rotor1333 are disconnected and shaft 1331 is no longer coupled to roll inputgear 1372. This allows roll input gear 1372 to rotate without rotatingadjustment input gear 1361 as clutch 1392 is disengaged.

Roll input gear 1372 drives roll output gear 1373 of roll system geartrain 1371. Roll output gear 1373 is mounted on a pair of bearings. Thepair of bearings is mounted on shaft 1322 of brake 1393. Roll outputgear 1373 is engaged with roll ring gear 1370.

Shaft 1322 of brake 1393 is rotatably mounted in housing 1394 using abearing on each end of shaft 1322. Adjustment output gear 1362 ofinstrument manipulator positioning system gear train 1360 is fixedlymounted on shaft 1322 so that when shaft 1331 is free to spin,adjustment output gear 1362 rotates. Adjustment output gear 1362 isdriven by adjustment input gear 1361 of instrument manipulatorpositioning system gear train 1360.

A hub 1324 of brake 1393 is mounted on shaft 1322 adjacent a body 1323that includes an electromagnetic coil and permanent magnets. Body 1323is affixed to drive housing 1394. An armature 1325 is connected to hub1324 by leaf springs. When the electromagnetic coil in body 1323 is notenergized, armature 1325 is affixed to body 1323 by the magnetic linesof flux of permanent magnets in body 1323. Thus, in this state, shaft1322 is connected to housing 1394, e.g., shaft 1322 is connected toground. Thus, shaft 1322 cannot spin and so adjustment output gear 1362of instrument manipulator positioning system gear train 1360 is held inposition and cannot rotate. When power is applied to the electromagneticcoil in body 1323, a magnetic field is generated that cancels themagnetic field of the permanent magnets in body 1323, and leaf springsconnecting hub 1324 and armature 1325 pull armature 1325 upward andseparate armature 1325 from body 1323. Thus, shaft 1322 is free to spin,i.e., brake 1393 is released.

Roll output gear 1373 of roll system gear train 1371 drives roll ringgear 1370. Adjustment output gear 1362 of instrument manipulatorpositioning system gear train 1360 drives adjustment ring gear 1341. Oneend of brake shaft 1322 is coupled to a second digital potentiometer1351 that is mounted on drive housing 1394. Digital potentiometer 1351measures the absolute position of adjustment ring gear 1341 with respectto the mechanical ground.

Thus, first digital potentiometer 1350 (FIG. 13B) measures the absoluteposition of roll ring gear 1370 with respect to the mechanical ground,while second digital potentiometer 1351 measures the absolute positionof adjustment ring gear 1341 with respect to the same mechanical ground.In the roll mode (see Table 1) when roll ring gear 1370 and adjustmentring gear 1341 rotate synchronously, first digital potentiometer 1350and second digital potentiometer 1351 both turn. In the adjustment mode,adjustment ring gear 1341 is braked and so second digital potentiometer1351 does not turn. However, first digital potentiometer 1350 does turnand is incremented. The configuration of the surgical device assembliesis determined by the difference between first digital potentiometer andsecond digital potentiometer in the adjustment mode, i.e., by therelative position of roll ring gear 1370 to adjustment ring gear 1341.

As described above, patient side support system 210E is used for avariety of surgical procedures that use various combinations ofinstruments. Also as described above, the instruments in one aspect aregrouped into sets of instruments based on the shaft characteristics ofthe instruments, e.g., standard surgical instrument, advanced surgicalinstruments, and camera instruments. Also, in some surgeries, a manualinstrument or instruments may be used in conjunction with theteleoperated surgical instruments.

In one aspect, each standard surgical instrument has a shaft with aspecified outer diameter, e.g., a 6 mm (0.237 in) outer diameter. Theouter diameter of the shaft of an advanced surgical instrument is largerthan the outer diameter of the shaft of the standard surgicalinstrument. In one aspect, advanced surgical instruments have shaftswith outer diameters of 8 mm (0.315 in) and 12 mm (0.473 in). Examplesof advanced surgical instruments include a stapler and a vessel sealer.

System 210E has the flexibility to accommodate a specific combination ofthese instruments for a particular procedure, as well as a camerainstrument. In one aspect, a number of different entry guides are usedin system 210E. Each different entry guide includes a differentconfiguration of channels, as described more completely below. Thechannels include standard instrument channels, advanced instrumentchannels, camera channels, and manual channels in one aspect. In anotheraspect, manual channels are not included and can be eliminated orreplaced with a standard instrument channel or an advanced instrumentchannel. The standard instrument channels are sometimes referred to asstandard surgical instrument channels. The advanced instrument channelsare sometimes referred to as advanced surgical instrument channels.

The selection of entry guides and cannula sizes for system 210E wasbased on clinical needs, system feasibility, logistics, andmanufacturability. The instrument channels in the entry guides weresized to include a sheath mounted on the surgical instrument. The sheathprevents tissue or entry guide features from catching on the instrumentjoints.

In one aspect, the minimum spacing between channels in an entry guidewas selected to provide a minimum webbing thickness based onmanufacturability, e.g., a minimum thickness between adjacent channelsof 0.046 inches (1.17 mm). Similarly, the minimum outer wall thicknessof the entry guide was selected based on manufacturability, e.g., aminimum outer wall thickness of 0.035 inches (0.89 mm). The diameter ofthe entry guide channel for manual instruments was made as large aspossible while maintaining the minimum outer wall thickness and minimumthickness between adjacent channels.

FIGS. 14A to 14J are illustrations of cross-sections of a family ofentry guides that can be used with system 210E. The inclusion of tenentry guides in the family is illustrative only and is not intended tobe limiting. The number of entry guides in the family depends, forexample, on the number of different types of surgical instruments usedin a surgical procedure and the number of surgical procedures thatrequire different shaped entry guides and/or different types and numbersof surgical instruments. In one aspect, each entry guide in the familyincludes the characteristics just described. The family of entry guidescan be grouped into kits of two or more entry guides. Each entry guideincludes a plurality of channels. A channel is defined by an interiorwall or by interior walls of the entry guide.

As indicated above, each entry guide is inserted in a cannula. Eachcannula has a common wall thickness. The wall of the cannula is made asthin as possible to minimize incision size, but thick enough to supportthe working loads. In addition, the thickness of the wall is largeenough that the distal end of the cannula does not have a knife edge.The entry guides were selected to minimize the number of different sizedcannulas required. For entry guides with a circular cross section, twocannula sizes were selected, e.g., cannulas with an inner diameter ofabout 25 mm (0.986 in) and about 31 mm (1.222 in). For entry guides witha non-circular cross section, the smallest circular cannula size isreported that permits that non-circular entry guide to roll about thelongitudinal axis of entry guide manipulator 230 assuming that roll isallowed. However, typically non-circular entry guides and cannulas donot roll.

Hence, the ten entry guides presented in FIGS. 14A to 14J require at aminimum three cannula sizes. A standard 25 mm inner diameter cannula isused with standard entry guide 701. A 31 mm inner diameter cannula isused with the other circular cross section entry guides. Both the 25 mmcannula and the 31 mm cannula have two sizes—a short length and a longlength—for accommodating different patient anatomies. The non-circularcross section cannulas would require a cannula with a 36 mm (1.420 in)inner diameter if roll was possible in the procedure. A non-circularentry guide placed between ribs typically would not be rolled.

The positions of instrument channels in the various non-circular crosssection entry guides were adjusted (inward) from hugging the outerperimeter of the entry guide to fit within limitations of the instrumentmanipulator positioning system, as described more completely below. Fourunique non-circular cross section entry guides are included in thefamily of entry guides, one in a horizontal configuration for transoralsurgery, one in a cross arm configuration for transoral surgery, and twoin a vertical configuration for intercostal surgery.

Entry guide 1401 (FIG. 14A) is referred to as a standard entry guide andis the same as entry guide 571S. Entry guide 1401 has a circular crosssection. Entry guide 1401 includes four channels. The four channels area camera channel 1401C and three standard surgical instrument channels1401S1, 1401S2, 1401S3. Camera channel 1401C has an oblong crosssection. Herein, an oblong channel refers to a channel having an oblongcross section. Standard surgical instrument channels 1401S1, 1401S2,1401S3 have a circular cross section. Herein, a circular channel refersto a channel having a circular cross section. In this aspect, each ofthe three circular standard surgical instrument channels 1401S1, 1401S2,1401S3 is the same size, i.e., has the same diameter, e.g., 0.310 inches(7.9 mm).

Entry guide 1402 (FIG. 14B) is a first example of an advanced instrumententry guide. Entry guide 1402 has a circular cross section. Entry guide1402 includes four channels. The four channels are an oblong camerachannel 1402C, a first circular advanced surgical instrument channel1402A1, a circular standard surgical instrument channels 1402S2, and asecond circular advanced surgical instrument channel 1402A3. In thisaspect, first and second circular advanced instrument channels 1402A1,1402A3 have a same diameter, e.g., 0.428 inches (10.9 mm).

Entry guide 1403 (FIG. 14C) is a second example of an advancedinstrument entry guide. Entry guide 1403 has a circular cross section.Entry guide 1403 includes four channels. The four channels are an oblongcamera channel 1403C, a first circular standard instrument channel1403S1, a circular advanced surgical instrument channel 1403A2, and asecond circular standard surgical instrument channels 1403S3. In thisaspect, first and second circular standard surgical instrument channels1403S1, 1403S3 have a same diameter, e.g., 0.310 inches (7.9 mm). In oneaspect, circular advanced surgical instrument channel 1403A2 is sizedfor a stapler, and has, for example, a diameter of 0.595 inches (15.1mm).

Entry guide 1404 (FIG. 14D) is a first example of a manual port entryguide. Entry guide 1404 has a circular cross section. Entry guide 1404includes four channels. The four channels are an oblong camera channel1404C, a first circular standard instrument channel 1404S1, a circularmanual channel 1404M, and a second circular standard surgical instrumentchannels 1404S3. In this aspect, first and second circular standardsurgical instrument channels 1404S1, 1404S3 have a same diameter, e.g.,0.310 inches (7.9 mm). In one aspect, circular manual channel 1404M hasa diameter of 0.671 inches (17 mm).

Entry guide 1405 (FIG. 14E) is a second example of a manual port entryguide. Entry guide 1405 has a circular cross section. Entry guide 1405includes four channels. The four channels are an oblong camera channel1405C, a first circular advanced instrument channel 1405A1, a circularmanual channel 1405M, and a second circular advanced surgical instrumentchannels 1405A3. In this aspect, first and second circular advancedsurgical instrument channels 1405A1, 1405A3 have a same diameter, e.g.,0.428 inches (10.9 mm). In one aspect, circular manual channel 1405M hasa diameter of 0.472 inches (12 mm).

Entry guide 1406 (FIG. 14F) is a third example of a manual port entryguide. Entry guide 1406 has a circular cross section. Entry guide 1406includes five channels. The five channels are an oblong camera channel1406C, three circular standard instrument channels 1406S1, 1406S2,1406S3, and a circular manual channel 1406M. In this aspect, each of thethree circular standard surgical instrument channels 1406S1, 1406S2,1405S3 is the same size, i.e., has the same diameter, e.g., 0.310 inches(7.9 mm). In one aspect, circular manual channel 1406M has a diameter of0.505 inches (12.8 mm).

Entry guide 1407 (FIG. 14G) is a first example of a transoral entryguide, i.e., entry guide 1407 is used in minimally invasive transoralsurgery. Entry guide 1407 can also be used in minimally invasivethoracic surgery. Entry guide 1407 has a non-circular cross section,e.g., an oblong cross section. The oblong cross section of entry guide1407 has a major axis 1490 and a minor axis 1491. Major axis 1490 isperpendicular to minor axis 1491. Entry guide 1407 includes threechannels. The three channels are an oblong camera channel 1407C and twocircular standard instrument channels 1407S1, 1407S3. In this aspect,first and second circular standard surgical instrument channels 1407S1,1407S3 have a same diameter, e.g., 0.310 inches (7.9 mm). First circularstandard surgical instrument channel 1407S1 has a lengthwise axis 1481.The oblong cross section of camera channel 1407C has a major axis 1482,and second circular standard surgical instrument channel 1407S2 has alengthwise 1483. Major axis 1482 is coincident with major axis 1490 ofthe oblong cross section of entry guide 1407. Lengthwise axis 1481 andlengthwise axis 1483 intersect major axis 1490. First and secondcircular standard surgical instrument channels 1407S1, 1407S3 havemirror symmetry about a minor axis 1491 of the oblong cross section ofentry guide 1407.

Entry guide 1408 (FIG. 14H) is a second example of a transoral entryguide. Entry guide 1408 has a modified triangle cross section. The crosssection is a non-circular cross section and is referred to as a modifiedtriangle cross section because the vertices of the triangle shape arerounded and one side of the triangle has a small arc in the center.Entry guide 1408 includes four channels. The four channels are an oblongcamera channel 1408C and three circular standard instrument channels1408S1, 1408S2, 1408S3. In this aspect, the three circular standardsurgical instrument channels 1408S1, 1408S2, 1408S3 have a samediameter, e.g., 0.310 inches (7.9 mm).

First circular standard surgical instrument channel 1408S1 has alengthwise axis 1485. The oblong cross section of camera channel 1408Chas a major axis 1486 and a minor axis 1487. Third circular standardsurgical instrument channel 1408S3 has a lengthwise axis 1488. Secondcircular standard surgical instrument channel 1408S2 has a lengthwiseaxis 1489.

Lengthwise axes 1485, 1488 intersect a line 1490 that includes majoraxis 1486. Line 1490 is referred to as a major axis 1490 of a crosssection of entry guide 1408. Lengthwise axis 1489 intersects a straightline 1491 that includes minor axis 1487. Line 1491 is referred to as aminor axis 1490 of a cross section of entry guide 1408. Major axis 1490and minor axis 1491 intersect at length wise axis of oblong camerachannel 1408C. Entry guide 1408 has minor symmetry about minor axis1491.

Entry guide 1409 (FIG. 14I) is a first example of a thoracic entryguide. Entry guide 1409 has a non-circular cross section that is a crosssection with two parallel sides connected by two arcs, e.g., anoblong-like cross section. Entry guide 1409 includes three channels. Thethree channels are an oblong camera channel 1409C and two circularstandard instrument channels 1409S1, 1409S3. In this aspect, the twocircular standard surgical instrument channels 1409S1, 1409S3 have asame diameter, e.g., 0.310 inches (7.9 mm).

Entry guide 1410 (FIG. 14J) is a second example of a thoracic entryguide. Entry guide 1410 has a non-circular cross section that is anoblong-like cross section. Entry guide 1410 includes three channels. Thethree channels are an oblong camera channel 1410C and two circularadvanced surgical instrument channels 1410A1, 1410A3. In this aspect,the two circular advanced surgical instrument channels 1410A1, 1410A3have a same diameter, e.g., 0.428 inches (10.9 mm).

Table 2 is a summary of the information presented above for entry guides1401 to 1410. The sizes presented are illustrative only and are notintended to limit the entry guides to the specific dimensions presented.

TABLE 2 Entry Guide OD or Cannula Entry Guide Configurations MaximumManual 2^(nd) Channel Dimension Lumen Main axis Name Descriptions (mm)(mm) (mm) (mm) Standard 1401 Camera, 25.0 — 26.4 — Standard Four Lumen:Camera, 31.0 — 32.4 — Advanced Vessel Vessel Sealer Sealer 1402 StandardFour Lumen: Camera 31.0 — 32.4 — Advanced Vessel Stapler Sealer 1403Standard Four Lumen: Camera 31.0 17.0 32.4 — Manual 1404 Manual StandardFour Lumen: Camera, 31.0 12.0 32.4 — Vessel Sealer Vessel Sealer withManual Manual 1405 Five Lumen: Camera 31.0  12.8. 32.4 — Manual 1406Manual Standard Three Lumen: Camera 35.4 — 36.8 14 Horizontal 1407Standard Four Lumen: Camera 35.4 36.8 23.0 Horizontal: 1408 StandardThree Lumen: Camera 32.5 — 33.9 19.7 Vertical 1409 Standard There Lumen:Camera 36.0 — 37.4 19.7 Vertical Vessel Sealer Vessel Sealer 1410

The ten entry guide configurations with the three cannulas were analyzedto determine the range of motion required and the trajectory to beimplemented in each of the four gearboxes. FIG. 15 is a process flowdiagram of a method used to perform the analysis.

In SELECT FAMILY OF ENTRY GUIDES 1501, a family of entry guides isselected. This process is equivalent to the considerations describedabove with respect to FIGS. 14A to 14J, and so is not repeated here. Ingeneral terms, the selection of entry guides in the family and thecannula sizes was based on clinical needs, system feasibility,logistics, and manufacturability. The clinical needs included thesurgical instruments needed for the various surgical procedures that canbe carried out by the minimally invasive surgical system. In the aboveexamples, the family includes entry guides for standard surgicalinstruments, advanced surgical instruments, manual surgical instruments,camera instruments, and combinations of these instruments. In addition,the entry guides are selected to facilitate using as few differentcannula sizes as possible in one aspect. The entry guide channelconfigurations are laid out according to logistics in use of thesurgical instruments and manufacturability of the entry guides.

After a family of entry guides has been selected, MODEL FIXED ENTRYGUIDE PARAMETERS process 1502 process is performed. Some of the entryguide parameters can be directly derived from the shape and size of theentry guide, without consideration of the instrument manipulatorpositioning system or the surgical device assembly. For example, acamera instrument channel is always centered on the Y-axis and thecenter of the camera instrument channel is positioned as far as possiblefrom the longitudinal axis of the entry guide. This provides the mostroom for the other surgical instrument channels and manual instrumentchannel(s), and results in an intuitive arrangement of the surgicalinstruments relative to the camera for the surgeon. Similarly, thechannels for the shafts of the first and third surgical deviceassemblies are typically positioned symmetrically about the camerachannel, at the perimeter of the entry guide, and as close as possibleto the camera channel. This provides the most room for the manualchannel and more flexibility for placing the channel for the shaft ofanother surgical device assembly mounted on the base assembly.

Upon completion of MODEL FIXED ENTRY GUIDE PARAMETERS process 1502,stress regions are drawn around each instrument lumen position showingthe allowable offset between the actual and ideal (minimum stress)instrument positions in STRESS REGION process 1503. The boundary of eachstress region is a line of isostress. Any point interior to the boundaryhas less stress than the stress on the isostress boundary.

Thus, minimum stress positions are first determined. In one aspect, theminimum stress position is chosen as the location where the bend in theshaft is a circular bend. With one end of the shaft fixed in place andanother part of the shaft having approximately two point contact withthe entry guide, the shaft follows a circular arc. The stress is beingapplied by a pure moment. This circular bending was taken as minimizingthe stress in the shaft over the bending length, e.g. over a six inch(152.2 mm) length. In Table 3, the ideal positions for the positioningelements and hence the surgical instrument shafts are given as (x, y)coordinates. The direction of x and y is defined at the location of eachpositioning element in the base assembly. The values of the (x, y)coordinates (in inches) in Table 3 provide the nominal location for eachinstrument insertion assembly. FIG. 16A is FIG. 5A redrawn with the (x,y) coordinate systems added. As is known to those of skill in the art,the coordinates in Table 3 can be converted to millimeters bymultiplying each coordinate by 25.4.

TABLE 3 Positioning Positioning Positioning Positioning Element ElementElement Element in Base in Base in Base in Base Assembly AssemblyAssembly Assembly Entry Guide 432_0 432_1 432_2 432_3 Ref. No. X Y X Y XY X Y 1401 0.000 0.245 0.288 −0.094 0.000 −0.303 −0.288 0.094 1402 0.0000.363 0.361 0.000 0.000 −0.353 −0.361 0.000 1403 0.000 0.363 0.406 0.1100.000 −0.250 −0.406 −0.110 1404 0.000 0.363 0.406 0.110 — — −0.406−0.110 1405 0.000 0.363 0.361 0.000 — — −0.361 0.000 1406 0.000 0.3630.420 0.110 −0.286  −0.308 −0.420 −0.110 1407 0.000 0.000 0.506 0.0000.000 −0.414 −0.506 0.000 1408 0.000 0.000 0.506 0.000 0.000 −0.414−0.506 0.000 1409 0.000 0.393 0.156 0.000 0.000 −0.451 −0.156 0.000 14100.000 0.461 0.111 0.000 0.000 −0.453 −0.111 0.000

Transoral and thoracic entry guides 1407 to 1410 only use two of thethree instrument manipulators, but positions are specified forpositioning elements in all three base assemblies. This is done to avoidcollisions and to provide a gap for a sterile drape. Typically, whenonly two manipulator assemblies and associated surgical instruments areused with an entry guide, base assembly 432_1 and base assembly 432_2are used to position the two manipulator assemblies.

To facilitate placing the channels in the entry guide closer together tominimize the cannula diameter, the shafts of the surgical instrumentsare angled from the instrument housings (See FIG. 4B) and bent againstthe entry guide as they pass through the cannula. This makes up forspace lost to the shaft bearings and lost to the wall thickness of theinstrument housing. FIG. 16B illustrates a surgical instrument 1660 witha shaft 1667 that is entering an entry guide 1670 mounted in a cannula.Shaft 1667 is bent against entry guide 1670. Surgical instrument 460 isan example of surgical instrument 1660. FIG. 16C is a schematic top viewof three surgical instruments 1660_1, 1660_2, 1660_3 mounted asillustrated in FIGS. 3A and 3B for surgical instruments 260_1, 260_2,260_3.

With one end of shaft 1667 fixed at the instrument housing and anotherpoint on shaft 1667 having approximately two point contact with a wallof the channel in entry guide 1670 (FIG. 16B), shaft 1667 follows acircular arc as depicted in FIG. 16B. The amount of bending or angle θneeded is a function of a distance L of the bottom of the instrumenthousing to the top of entry guide 1670, and the relative distances ofthe channel from adjacent instrument housing and lumens. Angle θ is theshaft exit angle from the housing. Distance δ is distance from a centerof shaft 1667 to an outer diameter of a bearing B (FIG. 16C) mounted atthe proximal end of shaft 1667. Distance h is a housing theoreticalsharp dimension that is used to show the derived location of theinstrument housing relative to the channel. Distance G is a minimumdistance that is maintained between adjacent instrument housings.

The circular bending assumptions minimize the stress in the shaft overthe bending length assuming the worst-case insertion depth L. However,other bending can be achieved as needed to provide additional offsetbetween the instrument housing and the entry guide lumen. This S-bendingincreases the shaft stress as a function of its magnitude and direction(either perpendicular or in-line to the circular bend). As used herein,an S-shaped bend, e.g., S-bending, is created when a moment and a forceare applied simultaneously to the shaft. To understand how muchS-bending can be tolerated, for a given shaft material, a region boundedby an isostress boundary is plotted around the ideal instrumentlocation. The positioning element can be offset as needed to insert theshaft into the channel so long as the stress on the shaft remains on orwithin the isostress boundary. If the positioning element is moved fromthe ideal position, extra shaft bending is imposed on the instrumentshaft, but the stresses associated with the extra shaft bending arewithin acceptable stress levels so long as the position of thepositioning element, and hence the instrument shaft, remains within theisostress boundary.

In one aspect, the shaft material for the standard surgical instrumentswas stainless steel, e.g., a precipitation hardened stainless steel suchas 17-4 or 17-7 stainless steel condition H1050. However, for theadvanced surgical instruments, a different material is used. To toleratethe increased bend angle on a larger shaft, it is necessary to select adifferent material for the shafts of the vessel sealer and staplerinstruments.

The advanced surgical instruments have high strength plastic shafts toallow for bending through the cannulas. In one aspect, the shafts aremade from a polyether ether ketone (PEEK) plastic. PEEK plastic is anorganic polymer thermoplastic. In one aspect, a PEEK plastic with aflexural modulus of 11.8 GPa (1,711 ksi) is selected for the shafts ofthe advanced surgical instruments. The tensile fatigue of this PEEKplastic at 10⁷ cycles is a tensile strength of about 14,500 psi. A PEEKplastic having these characteristics is manufactured by Victrex®Manufacturing Limited as PEEK 450GL30. (VICTREX is a registeredtrademark of Victrex Manufacturing Limited of Lancashire FY5 4QD, UnitedKingdom.) Alternative grades of PEEK with higher stiffness areavailable. The alternative grades of PEEK have a modulus of elasticityof 45 GPa and 22 GPa. These grades might be required for some advancedsurgical instruments to prevent shaft buckling under high cable tension.

In FIG. 17, stress regions, sometimes called stress profiles, bounded bylines of isostress, i.e., bounded by isostress boundaries are presentedfor each positioning element and the associated entry guide channelshowing the allowable offsets from ideal (minimum stress) instrumentshaft positions. Each region has a shape that is roughly a cross sectionof an American football shape, i.e., a cross section of an oblatespheroid shape. The stress on the shaft of an instrument is acceptableif the shaft is positioned at a location within the isostress boundary.Thus, the stress regions in FIG. 17 are regions of acceptable stressassociated with bending of a shaft of an instrument. The referencenumeral for each stress profile points at the ideal position based onthe information in Table 3, which is at the center of the stressprofile. A first portion of the reference numeral is the referencenumeral of corresponding channel in FIGS. 14A to 14J and this isfollowed with a _P to indicate that the reference numeral refers to aposition. For example, 1408S0_P is the ideal position for the camerainstrument shaft when inserted in channel 1408S0 in entry guide 1408.

FIG. 17 shows that the ideal locations of the camera instrument shaftwith respect to channels 1401S0_P to 1410S0_P fall on a straight line,which is the positive portion of the y-axis of the entry guidemanipulator coordinate system. An isostress boundary is not determinedfor the camera instrument shaft, because as described above, the camerainstrument is pre-bent and so the shaft is not subjected to bending asin passes through an entry guide.

The stress profiles for the instrument shafts controlled by thepositioning element associated with base assembly 432_1 are primarilyalong the x-axis to the right of the y-axis, e.g., the stress profileshaving centers 1401S1_P to 1410S1_P as illustrated in FIG. 17. In FIG.17, the stress profiles for the instrument shafts controlled by thepositioning element associated with base assembly 432_2 are below thex-axis, e.g., the stress profiles having centers 1401S2_P to 1410S3_P,1406S2_P, and 1408S2_P to 1410S2_P, in this aspect.

The stress profiles for the instrument shafts controlled by thepositioning element associated with base assembly 432_3 are notpresented in FIG. 17. The reason is that for each (x, y) value defininga boundary of a stress profile the instrument shafts controlled by thepositioning element associated with base assembly 432_1, thecorresponding value on a boundary of a stress profile of an theinstrument shaft controlled by the positioning element associated withbase assembly 432_3 is (−x, −y). Therefore, when a first trajectory isdetermined for the positioning element associated with base assembly432_1, a second trajectory for the positioning element associated withbase assembly 432_3 is the negative of the first trajectory.Accordingly, analysis of the stress data associated with positions1401S1_P to 1410S1_P is sufficient to determine the same information ofthe positioning element associated with base assembly 432_3.

The stress regions generated in STRESS REGION process 1503 are used inSELECT POSITIONS process 1504. Initially in process 1504, a decisionneeds to be made on whether to use a linear trajectory gearbox (FIGS.10C, 10D) or a circular trajectory gearbox (FIGS. 10A, 10B).

Thus, the endpoints of a preliminary trajectory are defined to limit theoverall range of motion required. For the positioning element associatedwith the camera instrument, the range of motion is from position 1701 to1702 in the (x, y) coordinate system. For the positioning elementassociated with the first surgical instrument that is coupled to thefloating platform in base assembly 432_1, the range of motion is fromposition 1703 to 1704 in the (x, y) coordinate system. Finally, thepositioning element associated with the second surgical instrumentcoupled to the floating platform in base assembly 432_2, the range ofmotion is from position 1705 to 1706 in the (x, y) coordinate system.

After the ranges of motion are defined, the trajectories and thepositions that make up the trajectories are selected. For the camerainstrument, a linear trajectory is required. Thus, a linear trajectorygearbox is selected for the camera instrument. For the first surgicalinstrument, the stress profiles in FIG. 17 show that a straight linedrawn between point 1703 and 1704 intersects all the stress profiles.Therefore, the stress on the first surgical instrument shaft is within astress profile for each of the channels for points along the x-axisbetween points 1703 and 1704. Thus, a linear trajectory gearbox isselected for the first and third surgical instruments.

For the second surgical instrument, a straight line between points 1705and 1706 does not intersect all of the stress profiles and so a lineartrajectory is not acceptable. To determine the circular trajectory, aniterative process is used to find a constant radius arc that includespoints 1705 and 1706 and that intersects all the stress profiles.Constant radius arc 1710 that includes points 1705 and 1706 andintersects all the stress profiles is selected as the trajectory for thesecond surgical instrument.

Next, a set of positions are created on each trajectory for thepositioning element. Each selected position is on a boundary or within astress profile. While the selected positions assure that the stress onthe instrument shaft is acceptable, there is the possibility that whenadjacent instruments are moved to the selected positions, the instrumenthousings collide. Thus, the relationships of the instruments housings atthe selected positions are analyzed to assure that the positions do notresult in any collisions.

At each actual position, corresponding instrument housing is drawn basedon the layout of FIG. 16C. To avoid over defining the problem, a subsetof entry guides in the family of entry guides is empirically selected.Adjacent surgical instrument housings for each entry guide configurationare paired, and the gap between the housing is measured. If there is acollision, the gap between the housings is set at predetermined gap G,e.g., 0.100 inches (2.54 mm) and the selected positions are adjusted toobtain this spacing. If there is not a collision, the gap between theinstrument housing is saved for a final verification of thetrajectories. This process is repeated for each entry guide in thesubset of entry guides. The predetermined gap is also used to define theoffsets for the camera-positioning element. For the positions that arenot limited by the clearance with an adjacent instrument housing,positions are selected according to convenient properties, such as beingevenly spaced along the trajectory or where instrument shaft stress isminimized.

The square boxes along the x-axis in FIG. 17 represent the positions onthe linear trajectory of the first surgical instrument. The positionsfor a linear trajectory are not as critical because, as described above,the positioning element is not constrained to moving in a singledirection. In one aspect, the linear trajectory uses some of the pointsmore than once as the trajectory moves back and forth along thetrajectory based on the design of the linear gearbox. The square boxesalong arc 1710 in FIG. 17 represent the positions on the circulartrajectory of the second surgical instrument.

FIG. 18A illustrates the surgical instrument and camera instrumenttrajectories and ranges of motion of the output pins of gearboxes1842_0, 1842_1, 1842_2 for the family of entry guides in FIGS. 14A to14J. The plot is oriented looking down the cannula, with each gearboxposition labeled. The trajectory of the output pin of gearbox 1842_3(not shown) is not drawn because it is taken as the negative of thetrajectory and range of motion of gearbox 1842_1. As shown, thetrajectory of the output pin of gearbox 1842_3 is circular and the othertrajectories of the other three gearboxes are linear. Table 4 givevalues associated with the reference numbers in FIG. 18 for entry guides1401 to 1410.

TABLE 4 Reference No. Dimension (inches) 1801 0.461 (11.69 mm) 18020.245 (6.21 mm) 1803 0.208 (5.07 mm) 1804 0.454 (11.51 mm) 1805 0.250(6.34 mm) 1806 0.454 (11.51 mm) 1807 0.040 (1.01 mm) 1808 0.177 (4.49mm)

To reduce the range of motion of the camera instrument, in one aspect,two camera instruments are used in the surgical system, e.g., surgicalsystem 200C. The first camera instrument is used with all entry guidesexcept entry guides 1407 and 1408. The second camera instrument is usedonly for entry guides 1407 and 1408. The difference between the twocameras is the location of the shaft bend. FIGS. 19A and 19B areschematic illustrations of camera instruments 1960A and 1960B. Camerainstrument 260_0 is an example of either camera instrument 1960A orcamera instrument 1960B.

Lines 1900A and 1900B represent planes 1900A and 1900B, respectivelythat are perpendicular to the page. Plane 1900A bisects a first pair ofdrive disks of camera instrument 1960A that provide motion to the distalarticulating joints of camera instrument 1960A. The location of thestart of the bend in shaft 1967A is defined by the distance from thestart of the bend in the shaft to plane 1900A. For the first camerainstrument, the distance is X1, e.g., 1.739 inches (44.10 mm). Plane1900B bisects a first pair of drive disks of camera instrument 1960Bthat provide motion to the distal articulating joints of camerainstrument 1960B. For the second camera instrument, the distance is X2,e.g., 1.833 inches (46.48 mm).

The use of the two camera instruments reduces the range of motionrequired by the linear gearbox associated with the camera instrument tothe range presented in FIG. 18 instead of the range of motion of 0.0 to0.461 inches (0.0 to 11.69 mm) shown in FIG. 17. In another aspect, onlya single camera instrument is used.

The range of motion of the gearboxes for the three surgical instrumentsis 0.246 inches (6.24 mm) in the radial direction and 0.217 inches (5.50mm) in the lateral direction. The camera gearbox has a range of motionof 0.216 inches (5.48 mm) in the radial direction. Hence, the combinedranges of motion required by all the instruments are 0.246 inches (6.24mm) in the radial direction and 0.217 inches (5.50 mm) in the lateraldirection.

The order of the entry guides as moved by the positioning system inentry guide manipulator is defined by circular gearbox positions for thesecond surgical instrument. In Table 5, the relative positions arespecified as a function of the output gear angle in the circulargearbox.

TABLE 5 Entry Guide Ref. No. 706 703, 704 701 702, 705 707, 708 709, 710Output 0° 77° 117° 133.9° 150.8° 161° Gear Angle in Gearbox

In the above analysis, the bending stress associated with a shaft of aninstrument was determined only for the instrument designed to beinserted in a particular channel of the entry guide. For example, astandard surgical instrument with a smaller diameter shaft was notconsidered to be inserted in one of the larger diameter channelsdesigned for an advanced surgical instrument.

However, in another aspect, it was assumed that a bushing would beinserted in a larger diameter channel so that a standard surgicalinstrument could be passed through the channel designed, for example,for an advanced surgical instrument. Thus, the stress analysis wasrepeated for a set of guide tubes where a standard surgical instrumentis allowed to be used with a guide tube channel designed, for example,for an advanced surgical instrument. Also, the analysis assured thatinstrument collisions were not a problem. Finally, the analysis inaddition to the constraints imposed by the different channel locationsin the entry guides also specified a draping position for each of theinstrument manipulators. In particular, the instrument manipulators weremoved apart so that draping was facilitated. The result of this analysiswas the second set of gearboxes that are illustrated in FIGS. 11A to11K.

The analysis of the entry guides in combination with the drapingposition found that each instrument manipulator, e.g., each surgicaldevice assembly, must be moved to one of seven locations to accommodatethe set of entry guides of interest. The first location is the drapinglocation, and the other six locations are based on the combination ofentry guide and surgical device assembly being used.

FIG. 18B illustrates the seven locations for the instrument manipulatorassociated with gearbox 942_0_2 (FIGS. 11A and 11B). FIG. 18Cillustrates the seven locations of output pin 1149_B in slot 1144_B(FIG. 11B). In FIGS. 18B to 18I, the coordinate systems are relative tothe manipulator assembly and not to any world coordinate system. TABLE6A presents values in inches for each of the dimensions shown in FIG.18B. TABLE 6B presents values in inches for each of the dimensions shownin FIG. 18C. The numbers in parentheses in TABLES 6A and 6B are inmillimeters.

TABLE 6B SX0_1 0.048 SY0_1 0.00 (1.22) (0.00) SX0_2 −0.232 SY0_2 0.000(−5.88) (0.00) SX0_3 −0.014 SY0_3 0.000 (−0.36) (0.00) SX0_4 −0.014SY0_4 0.000 (−0.36) (0.00) SX0_5 −0.131 SY0_5 0.000 (−3.32) (0.00) SX0_60.017 SY0_5 0.000 (0.43) (0.00) SX0_7 0.085 SY0_7 0.000 (2.16) (0.00)

TABLE 6A MX0_1 0.1880 MY0_1 0.0000 (4.77) (0.00) MX0_2 −0.0920 MY0_20.0000 (−2.33) (0.00) MX0_3 0.1265 MY0_3 0.0000 (3.21) (0.00) MX0_40.1265 MY0_4 0.0000 (3.21) (0.00) MX0_5 0.0091 MY0_5 0.0000 (0.23)(0.00) MX0_6 0.1568 MY0_5 0.0000 (3.98) (0.00) MX0_7 0.2250 MY0_7 0.0000(5.71) (0.00)

FIG. 18D illustrates the seven locations for the instrument manipulatorassociated with gearbox 942_1_2 (FIGS. 11C and 11D.) FIG. 18Eillustrates the seven locations of output pin 1149_D in slot 1144_D(FIG. 11D). TABLE 7A presents values in inches for each of thedimensions shown in FIG. 18D. TABLE 7B presents values in inches foreach of the dimensions shown in FIG. 18E. The numbers in parentheses inTABLES 7A and 7B are in millimeters.

TABLE 7A MX1_1 0.160 MY1_1 −0.042 (4.06) (−1.07) MX1_2 0.235 MY1_2−0.069 (5.96) (−1.75) MX1_3 0.160 MY1_3 −0.042 (4.06) (−1.07) MX1_40.076 MY1_4 0.070 (1.93) (1.78) MX1_5 0.076 MY1_5 0.070 (1.93) (1.78)MX1_6 0.076 MY1_5 0.069 (1.93) (1.75) MX1_7 0.076 MY1_7 0.069 (1.93)(−1.75)

TABLE 7B SX1_1 0.010 SY1_1 −0.042 (0.25) (−1.07) SX1_2 0.085 SY1_2−0.069 (2.16) (−1.75) SX1_3 0.010 SY1_3 −0.042 (0.25) (−1.07) SX1_4−0.074 SY1_4 0.070 (−1.88) (1.78) SX1_5 −0.074 SY1_5 0.070 (−1.88)(1.78) SX1_6 −0.197 SY1_5 0.091 (−5.00) (2.31) SX1_7 −0.261 SY1_7 0.089(−6.62) (2.26)

FIG. 18F illustrates the seven locations for the instrument manipulatorassociated with gearbox 942_2_2 (FIGS. 11E to 11H). FIG. 18G illustratesthe seven locations of output pin 1149_G in slot 1144_G (FIG. 11G).TABLE 8A presents values in inches for each of the dimensions shown inFIG. 18F. TABLE 8B presents values in inches for each of the dimensionsshown in FIG. 18G. The numbers in parentheses in TABLES 8A and 8B are inmillimeters.

TABLE 8A MX2_1 0.165 MY2_1 −0.012 (4.18) (−0.30) MX2_2 0.014 MY2_2 0.000(0.36) (0.00) MX2_3 0.024 MY2_3 0.000 (0.61) (0.00) MX2_4 0.084 MY2_40.000 (2.13) MX2_5 0.094 MY2_5 0.000 (2.38) (0.00) MX2_6 0.198 MY2_5−0.022 (5.02) (−0.56) MX2_7 0.198 MY2_7 −0.022 (5.02) (−0.56)

TABLE 8B SX2_1 0.015 SY2_1 −0.012 (0.38) (−0.30) SX2_2 −0.136 SY2_20.000 (−3.45) (0.00) SX2_3 −0.126 SY2_3 0.042 (−3.20) (1.07) SX2_4−0.066 SY2_4 0.070 (−1.67) (1.78) SX2_5 −0.056 SY2_5 0.070 (1.42) (1.78)SX2_6 0.048 SY2_5 −0.022 (1.22) (−0.56) SX2_7 0.048 SY2_7 −0.022 (1.22)(−0.56)

FIG. 18H illustrates the seven locations for the instrument manipulatorassociated with gearbox 942_3_2 (FIGS. 11I to 11J). FIG. 18I illustratesthe seven locations of output pin 1149_J in slot 1144_J (FIG. 11J).TABLE 9A presents values in inches for each of the dimensions shown inFIG. 18D. TABLE 9B presents values in inches for each of the dimensionsshown in FIG. 18E. The numbers in parenthesis in TABLES 9A and 9B are inmillimeters.

TABLE 9A MX3_1 0.160 MY3_1 0.042 (4.06) (1.07) MX3_2 0.235 MY3_2 0.069(5.96) (1.75) MX3_3 0.160 MY3_3 0.042 (4.06) (1.07) MX3_4 0.076 MY3_4−0.070 (1.93) (−1.78) MX3_5 0.076 MY3_5 −0.070 (1.93) (−1.78) MX3_6−0.047 MY3_5 −0.091 (−1.19) (−2.31) MX3_7 −0.111 MY3_7 −0.089 (−2.81)(−2.26)

TABLE 9B SX3_1 0.010 SY3_1 0.042 (0.25) (1.07) SX3_2 0.085 SY3_2 0.069(2.16) (−1.75) SX3_3 0.010 SY3_3 0.042 (0.25) (1.07) SX3_4 −0.074 SY3_4−0.070 (−1.88) (−1.78) SX3_5 −0.074 SY3_5 −0.070 (−1.88) (−1.78) SX3_6−0.197 SY3_5 −0.091 (−5.00) (−2.31) SX3_7 −0.261 SY3_7 −0.089 (−6.62)(−2.26)

In one aspect, a control system 2000 (FIG. 20A) of the surgical systemincludes an instrument manipulator positioning system compatibilitymodule 2010. Control system 2000 also has compatibility andconfiguration data 2015 that is stored in a memory and a systemmanagement module 2025.

In FIG. 20A, control system 2000 and system management module 2025 areillustrated as elements in a single location. This is for ease ofdescription and is not intended to be limiting. Typically, controlsystem 2000 and the system management module 2025 are distributedthroughout the surgical system and interconnected so that the variouscomponents can communicate as necessary. Also, those knowledgeable inthe field understand that a module can be implemented in hardware,firmware, stored computer code that is executed on a processor, or anycombination of the three.

In one aspect, instrument manipulator positioning system compatibilitymodule 2010 performs method 2050 (FIG. 20B). Prior to considering method2050 in further detail, it is helpful to understand some of the surgicalinstrument and entry guide inputs 2001. When sterile adapter assembly250 is mounted on manipulator assembly 240 (FIG. 4A) a switch isactivated that sends a signal to system management module 2025 and tocompatibility and configuration data 2015 indicating mounting of sterileadapter 2025. In response to this signal, control system 2000 activatesdrive motors in manipulator assembly 240 to mate drive disks inmanipulator assembly 240 with intermediate disks in sterile adapter 250.

When surgical instrument 260 is mounted in sterile adapter assembly 250,a second switch is activated that sends a signal to system managementmodule 2025 and to compatibility and configuration data 2015 indicatingmounting of surgical instrument 260. In response to this signal, controlsystem 2000 activates the drive motors in manipulator assembly 240 tomate the intermediate disks in sterile adapter assembly 250 with drivendisks in driven interface assembly 461 of surgical instrument 260.Controls system 2000 also activates the RFID reader 445 in manipulatorassembly 240 to read the RFID tag 455 on surgical instrument 260. Theidentification information read from RFID tag is supplied to systemmanagement module 2025 and to compatibility and configuration data 2015.

Thus, as each surgical instrument is mounted on system 210C, a signalindicating the mounting and information about the surgical instrumentare provided to SYSTEM READY check process 2051. Also, identificationinformation of cannula 275E and entry guide 270E are supplied to SYSTEMREADY check process 2051. In one aspect, RFID tags on cannula 275E andentry guide 270E are scanned by an RFID reader connected to controlsystem 2090 to obtain the identification information. In another aspect,a user enters the identification information of cannula 275E and entryguide 270E via a user interface provided by control system 2000, e.g., auser interface on the surgeon's control console. Also, theidentification information could be obtained via color, physicalfeatures such as pins on the mount paint, magnetic rings, etc.

If a user tries to use system 200C prior to SYSTEM READY check process2051 receiving the information from the surgical instruments and fromthe cannula and entry guide, SYSTEM READY check process 2051 activates afirst warning signal 2003 to system management module 2025. In responseto first active warning signal 2003, system management module 2025generates a warning to the user. For example, a message is presented ondisplay screens indicating that one or more components have not beenregistered with control system 2000 and that system operation isinhibited until successful registration. In addition to the visualmessage, an audio message or alarm may be generated.

When all the surgical instruments, the cannula, and the entry guide havebeen registered with control system 2000, SYSTEM READY check process2051 transfers processing to COMPATIBLE check process 2052. COMPATIBLEcheck process 2052 retrieves information from stored compatibility andconfiguration data 2015 that is associated with the entry guide mountedin system 200C. COMPATIBLE check process 2052 first checks that theentry guide is in the family of entry guides associated with theinstrument manipulator positioning system in entry guide manipulator230. If the entry guide is not in the family, check process 2052 sends asecond active warning signal 2003 to control system 2000 that in turnnotifies the user that the entry guide is not appropriate for use insystem 200C.

If the entry guide is in the family, check process 2052 determineswhether the mounted surgical instruments and camera instrument arecompatible with the mounted entry guide, and if the surgical instrumentsare compatible whether the surgical instruments are mounted in thecorrect locations. If either of these checks is not true, check process2052 sends a third active warning signal 2003 to control system 2000that in turn notifies the user of the problem with the surgicalinstrument configuration.

In one aspect, check process 2052 determines whether other elementsinstalled on system 200C, such as, drapes, foot pedal controlassemblies, master control assemblies, etc. are compatible based on theentry guide configuration and causes a warning message to be sent if anincompatibility is detected.

When check process 2052 determines that the various elements installedon system 200C are compatible, processing transfers to CONFIGURE SYSTEMprocess 2053. In one aspect, CONFIGURE SYSTEM process 2053 automaticallyactivates the instrument manipulator positioning system and moves theadjustment disk to the appropriate position so that each of theinstrument shafts are positioned for insertion into the entry guide. Inanother aspect, CONFIGURE SYSTEM process 2053 sends a first activeconfiguration message signal 2004 to system management module 2025. Inresponse to signal 2004, system management module 2025 sends a commandto a display module to inform the user to manually move the adjustmentdisk to the correct position.

In one aspect, CONFIGURE SYSTEM process 2053 also retrievesconfiguration data from compatibility and configuration data 2015 andsends the data to system management module 2025 to configure system 200Cfor operation with the entry guide. For example, system managementmodule 2025 uses the configuration data to adjust its user interface fora specific type of surgery given the type of entry guide installed.Module 2025 can use the configuration data to adjust user interfaceelements, allowable control modes, type and behavior of control modes,design of visible interface elements, audible tones, and any otheraspect of the user interface for either the surgeon or patient sideassistant, based on the entry guide configuration. Upon completion ofCONFIGURE SYSTEM process 2053, ENABLE FULL OPERATION process 2054 sendsan active enable signal 2005 to system management module 2025 toindicate that system 200C is properly configured to perform surgery withthe entry guide mounted in system 200C.

FIGS. 21A and 21B are illustrations of a side view of base assemblies2132_0 and 2132_1 mounted to a portion 2130 of entry guide manipulator230. In one aspect, an insertion assembly with an attached surgicaldevice assembly is connected to a floating platform in each of baseassemblies 2132_0 and 2132_1, but the insertion assembly with theattached surgical device assembly is not shown in FIGS. 21A and 21B.

Base assembly 2132_0 is connected to portion 2130 by a hinge assembly2133_0. A plane including a longitudinal axis of hinge assembly 2133_0is perpendicular to a plane including the longitudinal axis of entryguide manipulator 230. Similarly, base assembly 2132_1 is connected toportion 2130 by a hinge assembly 2133_1. Each of the other two baseassemblies that are not visible in FIG. 21A is similarly connected toportion 2130. In FIG. 21B, base assemblies 2132_0 and 2132_1 have beenpivoted to allow access to base assemblies 2132_0 and 2132_1 formaintenance or other actions. Base assemblies 2132_2 and 2132_3 arevisible in FIG. 21B.

FIG. 22A is a side view of base assemblies 2232_0 and 2232_1 mounted toa portion 2230 of entry guide manipulator 230. FIGS. 22B and 22C are topviews of base assemblies 2232_0, 2232_1, 2232_2, and 2232_2 mounted toportion 2230. In one aspect, an insertion assembly with an attachedsurgical device assembly is connected to a floating platform in each ofbase assemblies 2232_0, 2232_1, and 2232_2, but the insertion assemblywith the attached surgical device assembly is not shown in FIGS. 22A to22C.

Base assembly 2232_0 is connected to portion 2230 by a hinge assembly2233_0. Hinge assembly 2233_0 extends distally from entry guidemanipulator 230. Similarly, base assembly 2232_1 is connected to portion2230 by a hinge assembly 2233_1. Each of the other two base assemblies2232_2, and 2232_2 is similarly connected to portion 2230 by hinge2233_2 and hinge 2233_3, respectively. In FIG. 22C, base assembly 2232_1has been pivoted to allow access to base assembly 2232_1 for maintenanceor other actions.

FIGS. 23A and 23B are illustrations of a side view of base assemblies2332_0 and 2332_1 mounted to a portion 2330 of entry guide manipulator230. In one aspect, an insertion assembly with an attached surgicaldevice assembly is connected to a floating platform in each of baseassemblies 2332_0 and 2332_1, but the insertion assembly with theattached surgical device assembly is not shown in FIGS. 23A and 23B.

Base assembly 2332_0 is connected to portion 2330 by a set of rails.Similarly, base assembly 2332_1 is connected to portion 2330 by a set ofrails. Each of the other two base assemblies that are not visible inFIG. 23A is similarly connected to portion 2330. In FIG. 23B, baseassembly 2332_1 has been slid out on set of rails 2333_1 to allow accessto base assembly 2332_1 for maintenance or other actions. Base assembly2332_2 is visible in FIG. 23B.

In some of the above examples, the terms “proximal” or “proximally” areused in a general way to describe an object or element which is closerto a manipulator arm base along a kinematic chain of system movement orfarther away from a remote center of motion (or a surgical site) alongthe kinematic chain of system movement. Similarly, the terms “distal” or“distally” are used in a general way to describe an object or elementwhich is farther away from the manipulator arm base along the kinematicchain of system movement or closer to the remote center of motion (or asurgical site) along the kinematic chain of system movement.

As used herein, “first,” “second,” “third,” “fourth,” etc. areadjectives used to distinguish between different components or elements.Thus, “first,” “second,” “third,” “fourth,” etc. are not intended toimply any ordering of the components or elements, or any particularnumber of different types of elements, e.g., three elements of the sametype can be denoted as first, second, and third elements.

The above description and the accompanying drawings that illustrateaspects and embodiments of the present inventions should not be taken aslimiting—the claims define the protected inventions. Various mechanical,compositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of this description andthe claims. In some instances, well-known circuits, structures, andtechniques have not been shown or described in detail to avoid obscuringthe invention.

Further, this description's terminology is not intended to limit theinvention. For example, spatially relative terms—such as “beneath”,“below”, “lower”, “above”, “upper”, “proximal”, “distal”, and thelike—may be used to describe one element's or feature's relationship toanother element or feature as illustrated in the figures. Thesespatially relative terms are intended to encompass different positions(i.e., locations) and orientations (i.e., rotational placements) of thedevice in use or operation in addition to the position and orientationshown in the figures. For example, if the device in the figures wereturned over, elements described as “below” or “beneath” other elementsor features would then be “above” or “over” the other elements orfeatures. Thus, the exemplary term “below” can encompass both positionsand orientations of above and below. The device may be otherwiseoriented (rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly. Likewise,descriptions of movement along and around various axes include variousspecial device positions and orientations.

The singular forms “a”, “an”, and “the” are intended to include theplural forms as well, unless the context indicates otherwise. The terms“comprises”, “comprising”, “includes”, and the like specify the presenceof stated features, steps, operations, elements, and/or components butdo not preclude the presence or addition of one or more other features,steps, operations, elements, components, and/or groups. Componentsdescribed as coupled may be electrically or mechanically directlycoupled, or they may be indirectly coupled via one or more intermediatecomponents.

All examples and illustrative references are non-limiting and should notbe used to limit the claims to specific implementations and embodimentsdescribed herein and their equivalents. Any headings are solely forformatting and should not be used to limit the subject matter in anyway, because text under one heading may cross reference or apply to textunder one or more headings. Finally, in view of this disclosure,particular features described in relation to one aspect or embodimentmay be applied to other disclosed aspects or embodiments of theinvention, even though not specifically shown in the drawings ordescribed in the text.

We claim:
 1. An medical device comprising: a manipulator systemcomprising: a roll system coupled to first and second instrumentmanipulators, wherein the roll system is configured to roll the firstand second instrument manipulators as a group about a longitudinal axisof an entry guide, wherein the first instrument manipulator is couplableto a first instrument, and wherein the second instrument manipulator iscouplable to a second instrument; and an instrument manipulatorpositioning system coupled to the roll system and couplable to the firstand second instrument manipulators, wherein the instrument manipulatorpositioning system is configured to move at least one of the first andsecond instrument manipulators to simultaneously align shafts of firstand second instruments with different channels in an entry guide.
 2. Themedical device of claim 1: wherein the instrument manipulatorpositioning system comprises an adjustment ring gear; and wherein theroll system comprises a roll ring gear.
 3. The medical device of claim2, the manipulator system further comprising: a drive assembly coupledto the roll ring gear and coupled to the adjustment ring gear, whereinthe drive assembly is configured to differentially rotate the adjustmentring gear and the roll ring gear to cause the instrument manipulatorpositioning system to move the or each of the first and secondinstrument manipulators to simultaneously align shafts of the first andsecond instruments with the different channels in the entry guide. 4.The medical device of claim 3: wherein the drive assembly is configuredto hold the roll ring gear stationary; and wherein the drive assembly isconfigured to turn the adjustment ring gear while the roll ring gear isheld stationary.
 5. The medical device of claim 3: wherein the driveassembly is configured to hold the adjustment ring gear stationary; andwherein the drive assembly is configured to turn the roll ring gearwhile the adjustment gear is held stationary.
 6. The medical device ofclaim 3, wherein the drive assembly comprises: an instrument manipulatorpositioning system gear train configured to drive the adjustment ringgear; and a roll system gear train configured to drive the roll ringgear.
 7. The medical device of claim 3, wherein the drive assemblycomprises: a brake configured to selectively maintain one of theadjustment ring gear and the roll ring gear stationary.
 8. The medicaldevice of claim 3, wherein the drive assembly comprises: a drive motor;and a clutch configured to couple and de-couple the drive motor with theadjustment ring gear.
 9. The medical device of claim 7, wherein thedrive assembly comprises: a drive motor; and a clutch configured tocouple and de-couple the drive motor with the adjustment ring gear. 10.The medical device of claim 3, wherein the drive assembly furthercomprises a manually operated knob coupled to the adjustment ring gear.11. The medical device of claim 2, wherein the instrument manipulatorpositioning system further comprises: a first gearbox coupled to thefirst instrument and coupled to the adjustment ring gear; and a secondgearbox coupled to the second instrument and coupled to the adjustmentring gear.
 12. The medical device of claim 11, wherein the first gearboxcomprises: a gear; and a pin coupled to the gear, wherein the pindetermines the location of the first instrument.
 13. The medical deviceof claim 12, wherein the pin is mounted on a side surface of the gear,and wherein the pin has one degree of freedom.
 14. The medical device ofclaim 13, wherein the one degree of freedom comprises an arc with aconstant radius.
 15. The medical device of claim 12: wherein a sidesurface of the gear comprises a cam, wherein the pin rides on the cam;and wherein the pin has two degrees of freedom.
 16. The medical deviceof claim 12, the first gearbox further comprising a range of motionstop.